Hearing — Fiscal Year 2021 Health and Human Services Budget and Oversight of the Coronavirus Outbreak
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Printed House hearing record, Serial No. 116–103, titled The Fiscal Year 2021 Health and Human Services Budget and Oversight of the Coronavirus Outbreak, before the Subcommittee on Health of the Committee on Energy and Commerce on February 26, 2020. Anna G. Eshoo presides as chairwoman of the subcommittee. The witness list names Alex Azar, Secretary of the U.S. Department of Health and Human Services, Anthony S. Fauci, Stephen M. Hahn, Robert Kadlec, and Robert R. Redfield. A footnote says Azar did not answer submitted questions for the record by the time of publication. The submitted material includes letters on the case Texas v. United States and a Washington Post article on a flavored vape ban.
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“Hearing — Fiscal Year 2021 Health and Human Services Budget and Oversight of the Coronavirus Outbreak.”
Original at www.govinfo.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/chrg-chrg-116hhrg52377-chrg-116hhrg52377/
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THE FISCAL YEAR 2021 HEALTH AND HUMAN
SERVICES BUDGET AND OVERSIGHT OF THE
CORONAVIRUS OUTBREAK
HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON ENERGY AND
COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
SECOND SESSION
FEBRUARY 26, 2020
Serial No. 116–103
(
Printed for the use of the Committee on Energy and Commerce
govinfo.gov/committee/house-energy
energycommerce.house.gov
U.S. GOVERNMENT PUBLISHING OFFICE
52–377 PDF WASHINGTON : 2023
COMMITTEE ON ENERGY AND COMMERCE
FRANK PALLONE, JR., New Jersey
Chairman
BOBBY L. RUSH, Illinois GREG WALDEN, Oregon
ANNA G. ESHOO, California Ranking Member
ELIOT L. ENGEL, New York FRED UPTON, Michigan
DIANA DEGETTE, Colorado JOHN SHIMKUS, Illinois
MIKE DOYLE, Pennsylvania MICHAEL C. BURGESS, Texas
JAN SCHAKOWSKY, Illinois STEVE SCALISE, Louisiana
G. K. BUTTERFIELD, North Carolina ROBERT E. LATTA, Ohio
DORIS O. MATSUI, California CATHY MCMORRIS RODGERS, Washington
KATHY CASTOR, Florida BRETT GUTHRIE, Kentucky
JOHN P. SARBANES, Maryland PETE OLSON, Texas
JERRY MCNERNEY, California DAVID B. MCKINLEY, West Virginia
PETER WELCH, Vermont ADAM KINZINGER, Illinois
BEN RAY LujáńN, New Mexico H. MORGAN GRIFFITH, Virginia
PAUL TONKO, New York GUS M. BILIRAKIS, Florida
YVETTE D. CLARKE, New York, Vice Chair BILL JOHNSON, Ohio
DAVID LOEBSACK, Iowa BILLY LONG, Missouri
KURT SCHRADER, Oregon LARRY BUCSHON, Indiana
JOSEPH P. KENNEDY III, Massachusetts BILL FLORES, Texas
TONY CÁRDENAS, California SUSAN W. BROOKS, Indiana
RAUL RUIZ, California MARKWAYNE MULLIN, Oklahoma
SCOTT H. PETERS, California RICHARD HUDSON, North Carolina
DEBBIE DINGELL, Michigan TIM WALBERG, Michigan
MARC A. VEASEY, Texas EARL L. ‘‘BUDDY’’ CARTER, Georgia
ANN M. KUSTER, New Hampshire JEFF DUNCAN, South Carolina
ROBIN L. KELLY, Illinois GREG GIANFORTE, Montana
NANETTE DIAZ BARRAGÁN, California
A. DONALD MCEACHIN, Virginia
LISA BLUNT ROCHESTER, Delaware
DARREN SOTO, Florida
TOM O’HALLERAN, Arizona
PROFESSIONAL STAFF
JEFFREY C. CARROLL, Staff Director
TIFFANY GUARASCIO, Deputy Staff Director
MIKE BLOOMQUIST, Minority Staff Director
(II)
SUBCOMMITTEE ON HEALTH
ANNA G. ESHOO, California
Chairwoman
ELIOT L. ENGEL, New York MICHAEL C. BURGESS, Texas
G. K. BUTTERFIELD, North Carolina, Vice Ranking Member
Chair FRED UPTON, Michigan
DORIS O. MATSUI, California JOHN SHIMKUS, Illinois
KATHY CASTOR, Florida BRETT GUTHRIE, Kentucky
JOHN P. SARBANES, Maryland H. MORGAN GRIFFITH, Virginia
BEN RAY LujáńN, New Mexico GUS M. BILIRAKIS, Florida
KURT SCHRADER, Oregon BILLY LONG, Missouri
JOSEPH P. KENNEDY III, Massachusetts LARRY BUCSHON, Indiana
TONY CÁRDENAS, California SUSAN W. BROOKS, Indiana
PETER WELCH, Vermont MARKWAYNE MULLIN, Oklahoma
RAUL RUIZ, California RICHARD HUDSON, North Carolina
DEBBIE DINGELL, Michigan EARL L. ‘‘BUDDY’’ CARTER, Georgia
ANN M. KUSTER, New Hampshire GREG GIANFORTE, Montana
ROBIN L. KELLY, Illinois GREG WALDEN, Oregon (ex officio)
NANETTE DIAZ BARRAGÁN, California
LISA BLUNT ROCHESTER, Delaware
BOBBY L. RUSH, Illinois
FRANK PALLONE, JR., New Jersey (ex
officio)
(III)
C O N T E N T S
Page
Hon. Anna G. Eshoo, a Representative in Congress from the State of Cali-
fornia, opening statement .................................................................................... 2
Prepared statement .......................................................................................... 3
Hon. Michael C. Burgess, a Representative in Congress from the State of
Texas, opening statement .................................................................................... 4
Prepared statement .......................................................................................... 6
Hon. Frank Pallone, Jr., a Representative in Congress from the State of
New Jersey, opening statement .......................................................................... 7
Prepared Statement ......................................................................................... 8
Hon. Greg Walden, a Representative in Congress from the State of Oregon,
opening statement ................................................................................................ 9
Prepared statement .......................................................................................... 11
WITNESSES
Alex Azar, Secretary, U.S. Department of Health and Human Services ............ 12
Prepared statement .......................................................................................... 14
Answers to submitted questions 1
Anthony S. Fauci, Director, National Institute for Allergy and Infectious
Diseases, National Institutes of Health 2
Stephen M. Hahn, M. D., Commissioner, Food and Drugs and Drug Adminis-
tration 2
Robert Kadlec, M. D., Assistant Director, US Department of Health and
Human Services 2
Robert R. Redfield, Director, Centers for Disease Control and Prevention 2
SUBMITTED MATERIAL
Article of January 2020, ‘‘Lack of new antibiotics threatens global efforts
to contain drug-resistant infections’’ submitted by Mr. Shimkus .................... 96
Chart ‘‘FY 2020,’’ submitted by Ms. Dingell .......................................................... 99
Report of November 2019, ‘‘Ending the Cycle of Crisis and Complacency
in U.S. Global Health Security,’’ submitted by Ms. Brooks 3
Letter of June 13, 2018, to Mr. Azar and Ms. Verma, from four House
Committees to HHS and CMS regarding the case Texas v. United States,
submitted by Mr. Pallone .................................................................................... 101
Letter of December 7, 2018, to Mr. Azar and Ms. Verma, from four House
Committees to HHS and CMS regarding the case Texas v. United States,
submitted by Mr. Pallone .................................................................................... 106
Letter of April 8, 2019, to Mr. Azar and Ms. Verma, from five House Commit-
tees to HHS and CMS regarding the case Texas v. United States, submitted
by Mr. Pallone ...................................................................................................... 108
1 Mr. Azar did not answer submitted questions for the record by the time
of publication.
2 The witnesses did not answer the submitted questions for the record by
the time of publication.
3 The information has been retained in committee files and also is available
at https://docs.house.gov/meetings/IF/IF14/20200226/110589/HHRG-116-
IF14-20200226-SD003.pdf.
(V)
VI
Page
Letter of February 18, 2020, to Mr Pallone, et al., from Sarah Arbes, Acting
Assistant Secretary for Legislation, HHS, submitted by Mr. Pallone ............. 113
Article of October 25, 2019, ‘‘Trump campaign urges White House to soften
proposed flavored vape ban,’’ by Michael Scherer et al., Washington Post,
submitted by Ms. Eshoo ...................................................................................... 116
Letter of October 29, 2019, to Mr. Azar, HHS, from Mr. Pallone and Mr.
Wyden, from two Congressional Committees, submitted by Mr. Pallone ....... 126
Letter of June 27, 2019, letter from the Energy and Commerce Committee
examining HHS’s administration of the Medicaid program, submitted by
Ms. Eshoo .............................................................................................................. 129
Letter of February 26, 2020, to Ms. Eshoo and Mr. Burgess, by Jane M.
Adams, Vice President, Federal Affairs, Johnson & Johnson, submitted
by Ms. Eshoo ........................................................................................................ 134
Statement of February 26, 2020, from American Society for Microbiology,
submitted by Ms. Eshoo ...................................................................................... 135
Article of February 20, 2020, BioCentury entitled, ‘‘Biopharma industry, aca-
demics push back against demands for price controls on COVID-19 counter-
measures,’’ by Steve Usdin, submitted by Ms. Eshoo ....................................... 137
Article of January 30, 2020, Wall Street Journal entitled, ‘‘Pharma to the
Rescue,’’ by the Editorial Board, submitted by Ms Eshoo ................................ 139
THE FISCAL YEAR 2021 HEALTH AND HUMAN
SERVICES BUDGET AND OVERSIGHT OF
THE CORONAVIRUS OUTBREAK
WEDNESDAY, FEBRUARY 26, 2020
HOUSE OF REPRESENTATIVES,
SUBCOMMITTEE ON HEALTH,
COMMITTEE ON ENERGY AND COMMERCE,
Washington, DC.
The subcommittee met, pursuant to call, at 1:00 p.m., in the
John D. Dingell Room 2123, Rayburn House Office Building, Hon.
Anna G. Eshoo (chairwoman of the subcommittee) presiding.
Present: Representatives Eshoo, Engel, Matsui, Sarbanes, Luján,
Schrader, Kennedy, Cárdenas, Welch, Ruiz, Dingell, Kuster, Kelly,
Barragán, Blunt Rochester, Pallone (ex officio), Burgess, Upton,
Shimkus, Guthrie, Griffith, Bilirakis, Long, Bucshon, Brooks, Hud-
son, Carter, Gianforte, and Walden (ex officio).
Also present: Representatives DeGette and Schakowsky.
Staff present: Joe Banez, Professional Staff Member; Kevin Bar-
stow, Chief Oversight Counsel; Jacquelyn Bolen, Counsel; Jeffrey
C. Carroll, Staff Director; Kimberly Espinosa, Professional Staff
Member; Waverly Gordon, Deputy Chief Counsel; Tiffany
Guarascio, Deputy Staff Director; Stephen Holland, Health Coun-
sel; Zach Kahan, Outreach and Member Service Coordinator; Saha
Khaterzai, Professional Staff Member; Chris Knauer, Oversight
Staff Director; Una Lee, Chief Health Counsel; Kevin McAloon,
Professional Staff Member; Aisling McDonough, Policy Coordinator;
Meghan Mullon, Policy Analyst; Alivia Roberts, Press Assistant;
Tim Robinson, Chief Counsel; Kimberlee Trzeciak, Chief Health
Advisor; Rick Van Buren, Health Counsel; C. J. Young, Press Sec-
retary; Nolan Ahern, Minority Professional Staff, Health; Jennifer
Barblan, Minority Chief Counsel, Oversight and Investigations; S.
K. Bowen, Minority Press Secretary; William Clutterbuck, Minority
Staff Assistant; Jordan Davis, Minority Senior Advisor; Caleb
Graff, Minority Professional Staff Member, Health; Tyler Green-
berg, Minority Staff Assistant; Brittany Havens, Minority Profes-
sional Staff, Oversight and Investigations; Peter Kielty, Minority
General Counsel; Ryan Long, Minority Deputy Staff Director; Kate
O’Connor, Minority Chief Counsel, Communication and Technology;
James Paluskiewicz, Minority Chief Counsel, Health; Kristin
Seum, Minority Counsel, Health; Kristen Shatynsky, Minority Pro-
fessional Staff Member, Health; and Alan Slobodin, Minority Chief
Investigative Counsel, Oversight and Investigations.
Ms. ESHOO. The Subcommittee on Health will now come to order.
(1)
2
I just want all members to know that our witnesses today have
to leave at 5:00 p.m. So the questions for the first panel on the
HHS budget with the Secretary and welcome, Mr. Secretary—are
going to be limited to four minutes. In the second panel, on the
coronavirus response, those questions will be limited to 5 minutes,
which is the usual case, but only ten members are going to be able
to ask questions during that round. So I will have to be strict with
the gavel since the witnesses have a tight timeframe, and I know
that you will all cooperate with that.
And so let us begin.
Welcome, Mr. Secretary. We are glad that you are here. We have
a lot to take up, and every bit of it is, obviously, serious.
The Chair now recognizes herself for 5 minutes for her opening
statement.
OPENING STATEMENT OF HON. ANNA G. ESHOO, A REP-
RESENTATIVE IN CONGRESS FROM THE STATE OF CALI-
FORNIA
And let me begin with this, Mr. Secretary: I think that confusion
is the enemy of preparedness. Confusion is the enemy of prepared-
ness. I believe that the administration’s lack of coordination for the
coronavirus response is on full display. We all know that. Markets
are reacting, I think, at least in some part, to the lack of trusted
information, amongst many other factors.
Our government, across the government, has to speak with credi-
bility and authority. Instead, it is like a Greek chorus chanting on
the side of the stage. We have one saying one thing, the President
saying something else, and that adds to the confusion.
I think that there are key questions that need to be addressed
for the American people: What is the plan, the overall plan; should
this virus infect Americans in high numbers?
What is the plan for increasing diagnostic capacity, and what is
the target number for that? Dysfunctional tests, we all know, have
limited our ability to diagnose the virus, and the small number, it
could be said, of U.S. cases may reflect limited testing and not the
virus’s spread. But it is up to our professionals to put out with clar-
ity that kind of information.
What is the plan for protecting our healthcare workers that are
on the front lines of this? What is the plan to increase hospital ca-
pacity?
Now, in my view, the United States of America has the premier
professional public health professionals in the world—in the
world—our scientists, our doctors, and those that are heading up
the agencies, those that are part of the agencies. I think the prob-
lem rests more with administration people, one saying one thing,
others saying something else.
I think that the briefings that are done for the Congress, if I
might suggest, should be open to the public. There is no reason to
have secrets about this. And I say that because it raises the ele-
ment of fear with people. ‘‘There is something going on behind
closed doors that they are not telling us.’’
And it is a time for us, if I might use the expression, to give
them an inoculation of confidence. And certainly the virus triggers
fear, and I think the antidote for this is truth and transparency,
3
including informing the American people of a coordinated, fully-
funded government plan to keep us safe.
These are not things they can do for themselves. We are the
ones. You are certainly in the driver’s seat on this. And I think
that the funding request—and later in my questions, I will ask you
about that—is wholly inadequate.
Now, before requesting the emergency funding, the President’s
budget contained dangerous cuts that weaken our public health
frontline response, gut the healthcare safety net, and end programs
focusing on increasing our healthcare workforce.
So we are driving in the wrong direction. It is as if there is a
fire and the fire engine is going down the wrong end of the road
instead of to the fire. We need these resources in order to care for
the American people.
As the author of the Pandemic and All-Hazards Preparedness
Act, I know that the best way to fight outbreaks is by preparing
and investing in advance, not by rushing after a pandemic hits.
And while the virus is spreading, the President’s budget cuts al-
most $700 million from the CDC, $430 million from the national
institute focused on infectious diseases, $3 billion from the govern-
ment’s global health program. This is a jaw-dropping $1.6 trillion
cut from the very Federal programs that cover one in three Ameri-
cans. This doesn’t make any sense.
And the President’s budget virtually ends the workforce develop-
ment programs that trained more than a half a million clinicians
each year. I see them every week in my congressional district at
Stanford Medical Center and Lucile Packard Children’s Hospital.
So the budget weakens our public health safety net and it hurts
our country’s resiliency. The CDC, NIH—all of these agencies can-
not run on fumes—cannot run on fumes. And it is not even a Tesla
if it doesn’t have a battery that is going to last.
And if Americans are uninsured or underinsured, they are not
going to seek care, and that will contribute to the spread of the dis-
ease.
So I don’t know what is—the President often has promised
‘‘beautiful’’ healthcare. I don’t find beauty in what I just said, and
I am sorry that this is a part of it.
So, with that, I will have questions, and thank you again for
being here.
[The prepared statement of Ms. Eshoo follows:]
PREPARED STATEMENT OF HON. ANNA G. ESHOO
Confusion is the enemy of preparedness.
The Administration’s lack of coordination for the coronavirus response is on full
display and the markets are reacting to the lack of trusted information, amongst
many factors.
Our government must speak with credibility and authority.
•That means answering key questions for the American public:
•What is the plan should this virus infect Americans in high numbers?
What is the plan for increasing diagnostic capacity and what is the target num-
ber? Dysfunctional tests have limited our ability to diagnosis the virus. The small
number of U.S. cases may reflect limited testing, not the virus’s spread.
•What is the plan for protecting our healthcare workers?
•What is the plan to increase hospital capacity?
4
The virus triggers fear and I think the antidote for this is truth and transparency,
including informing the American people of a coordinated, fully-funded government
plan to keep us safe.
Instead of taking this situation seriously, the President has sent Congress a
coronavirus funding request that is inadequate for this emergency.
And before requesting the emergency funding, the President’s budget contain dan-
gerous cuts that weakens our public health frontline response, guts the healthcare
safety net, and ends programs focused on increasing our healthcare workforce.
As the author of the Pandemic and All Hazards Preparedness Act, I know that
the best way to fight outbreaks is by preparing and investing in advance, not by
rushing after a pandemic hits.
While the virus is spreading, the President’s budget cuts almost $700 million from
the CDC, $430 million from the National Institute focused on infectious diseases,
$3 billion from the government’s global health program . . . and a jawdropping $1.6
trillion from the federal programs that cover one in three Americans.
And the President’s budget virtually ends the workforce development programs
that train more than half a million clinicians each year.
The President’s budget weakens our public health safety net, hurting our coun-
try’s resiliency. If Americans are uninsured or underinsured, then they won’t seek
care and will contribute to the spread of the disease.
The President has often promised ‘‘beautiful’’ healthcare, but his HHS budget
shows an ugly truth.
The people of our country need a swift advancement of a strong, strategic funding
package that addresses the scale and seriousness of this public health crisis.
The Chair now recognizes Mr. Burgess, the ranking member of
our subcommittee, for his 5 minutes for his opening statement.
OPENING STATEMENT OF HON. MICHAEL C. BURGESS, A
REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS
Mr. BURGESS. And I thank the Chair.
Thank you, Secretary, for being here. Always great to see you in
our committee. I hope the feeling is mutual; you always are grate-
ful to be here at our committee.
I just have to say, Madam Chair, that two weeks ago I was criti-
cized rather severely for even suggesting that we needed a
coronavirus hearing. The work we were doing that day, which was
a bill that was never going to become law, was so important that
we didn’t need to do that hearing. We did need to do that hearing.
I am grateful we are having it today. I am grateful we have the
Secretary.
Now, this hearing is also being coincidently run with the Presi-
dent’s budget proposal for fiscal year 2021. And that is a lot of stuff
to cover in one hearing, but I guess we will do our best, Mr. Sec-
retary.
So let me just say, I do appreciate the administration’s commit-
ment to healthcare. I appreciate the commitment to lowering
healthcare costs and reducing the complexity of the system so that
patients can more easily access their care.
One thing the administration and, Mr. Secretary, particularly
you led on was advancing kidney health for Americans. That trend
continues in the Health and Human Services budget proposal and
the support for H.R. 5534, the Comprehensive Immunosuppressive
Drug Coverage for Kidney Transplant Patients Act.
As you know, Mr. Secretary, this bill would extend Medicare cov-
erage of immunosuppressive drugs past the current 36-month limit.
A patient with a kidney transplant needs to take
immunosuppressives or their body will ultimately reject the graft,
causing the patient to return for dialysis treatment.
5
A kidney transplant is indeed an investment in the future of that
recipient patient, and this bill will help protect that investment. I
have worked on this policy for a decade, and I am thankful it has
been highlighted as a priority by the administration. It is time for
Congress to finally pass this commonsense legislation.
The budget also continues the work of the SUPPORT Act, one of
the major pieces of legislation passed in the last Congress, by mak-
ing clear that the opiate epidemic and programs in the oversight
investigation—and making sure that the opiate epidemic and re-
sponse programs are indeed a priority.
In our Oversight and Investigations Subcommittee, we have
heard from various States about the efforts they are making to
help those with substance use disorder. Funding for these State
opiate response grants is imperative to allow States to find the in-
novative ways to combat this crisis.
I also appreciate the fact that the administration included Hyde
Amendment pro-life protections in all proposed funding language.
It is important to ensure that Federal funds are not used to per-
form abortions. And I hope as this subcommittee moves forward
with reauthorizations and the Appropriations Committee puts to-
gether the bills for fiscal year 2021, they will maintain those pro-
tections.
Other important programs and policies are receiving increased
funding, including: the Maternal and Child Health Block Grant,
the Health Resources and Services Administration’s Maternal
Health in America initiative, and the 340B drug pricing program.
Funding increases for the Centers for Disease Control and Preven-
tion’s influenza program are particularly important as we now face
this worldwide coronavirus outbreak.
Which brings me to the novel coronavirus. And it has infected
over 80,000 individuals worldwide, and proven to be more deadly
than SARS. I appreciate the Trump administration’s vigilance and
rapid response efforts.
Mr. Secretary, let me just say, I was so heartened—I think it
was four Fridays ago when you came on the air and said there was
a limit to people being able to come into this country from China.
And I thought it was important that the administration say that.
And I believe that is one of the central things—my thesis is that
is one of the central things that has provided us at least a little
breathing room as this virus erupts around the world. We are, for-
tunately, not as affected as some other countries. Now it is incum-
bent upon us to make sure that we utilize that time wisely.
Certainly, the Pandemic and All-Hazards Preparedness Act,
which was worked on by this subcommittee in the last Congress
and finally passed at the beginning of this Congress—important
piece of legislation. I would have liked for us to have done real-time
hearings updating, are we doing what was intended with that bill?
Is the stockpile responding appropriately to the authorizations that
we made?
And this is the type of information—rather then the political
rhetoric back and forth that we have heard, this is the type of in-
formation that I think would be helpful and, indeed, reassuring to
the American people.
6
You can’t ignore the fact of what has happened to the markets.
Today we are grateful that they have seemed to have rebounded
a little bit. But, look, we all know China has not been forthcoming
with information, and it is that uncertainty—that uncertainty—
that I believe it is one of the negative forces driving the market.
Mr. Secretary, I appreciate you being here today. We will have
multiple questions for you. I certainly look forward to your testi-
mony.
Thank you. I yield back.
[The prepared statement of Mr. Burgess follows:]
PREPARED STATEMENT OF HON. MICHAEL C. BURGESS
Thank you, Madam Chair. I want to thank Secretary Azar for being here today
to discuss President Trump’s Budget Proposal for fiscal year 2021 and the 2019
novel coronavirus, or COVID–19, outbreak.
I appreciate the Trump Administration’s commitment to healthcare, especially
lowering healthcare costs and the reducing the complexity of the healthcare system
so that patients can more easily access care. One thing the Administration, particu-
larly you, Secretary Azar, has led on is advancing kidney health for Americans.
That trend continues in the Health and Human Services Budget Proposal’s support
for H.R. 5534, the Comprehensive Immunosuppressive Drug Coverage for Kidney
Transplant Patients Act of 2019.
This bill would extend Medicare coverage of immunosuppressive drugs past the
current 36-month limit for kidney patients who do not obtain other health coverage.
A patient with a kidney transplant must take their immunosuppressive drugs or
their body will ultimately reject the kidney causing the patient to return to dialysis
treatment. A kidney transplant is an investment into the future of the recipient pa-
tient. This bill will protect that investment. I have worked on this policy for nearly
a decade, and I am thankful that this has been highlighted as a priority by the Ad-
ministration. This Congress is the time to finally pass this common-sense legisla-
tion.
This budget also continues the work of the SUPPORT Act, by making clear that
the opioid epidemic and response programs are a priority.
In the Oversight and Investigations Subcommittee we heard from various states
about the efforts they are making to help those with substance use disorder. Fund-
ing for these State Opioid Response Grants is imperative to allow states to find in-
novative ways to combat the opioid crisis.
I also appreciate that the Administration included Hyde Amendment and pro-life
protections in all proposed funding language. It is important to ensure that federal
funds are not used to perform abortions, and I hope that as this subcommittee
moves forward with reauthorizations and the Appropriations Committee puts to-
gether the bills for fiscal year 2021, that they will maintain those protections.
Other important programs and policies receiving increased funding including the
Maternal and Child Health Block Grant, the Health Resources and Services Admin-
istration’s Maternal Health in America Initiative, and the 340B Drug Pricing Pro-
gram. Funding increases for the Centers for Disease Control and Preparation’s in-
fluenza program is particularly important now as we face a worldwide coronavirus
outbreak.
This novel coronavirus, named COVID-19, has infected over 75,000 individuals
worldwide and has proven to be more deadly than SARS. I appreciate the Trump
Administration’s vigilance and rapid response efforts. The State Department issued
a level 4 travel advisory for China and the Administration has been appropriately
restrictive in allowing non-citizens who had traveled to China within the last 14
days from entering the U.S. It is a relief to know that our country is taking this
outbreak very seriously and has successfully limited the number of cases in the
United States; however, with increased global spread and community spread in
countries such as Italy, COVID–19 will become more difficult to contain.
Our agencies have worked together to protect the American people from this out-
break and have been successful in limiting infection of those in the U.S. This is
proof that the Pandemic and All-Hazards Preparedness and Advancing Innovation
Act of 2019 is working. Thanks to the work of this subcommittee in the last Con-
gress and the leadership of Rep. Susan Brooks and Chairwoman Eshoo, our public
health system is working as intended. I believe that our response efforts thus far
have shown that our public health system has adapted and improved since the Zika
7
and Ebola responses. Throughout those responses, Chairman Upton ensured that we
had robust hearings on those responses to ensure proper Congressional oversight
and understanding of the situations. I hope that we will be able to stick to that tra-
dition and hold a standalone hearing on COVID–19.
I do appreciate the CDC and other agencies’ transparency in providing multiple
telebriefings for Congressional staff each week so that Congress can be as informed
with the most up-to-date information as possible. I look forward to learning more
about COVID–19 and the challenges and successes of these response efforts.
Thank you for holding this important hearing. I yield back.
Ms. ESHOO. The gentleman yields back.
I want the ranking member to know the following. On January
30, I requested that, the following week, we have a hearing on the
coronavirus with the heads of the agencies. The Secretary leaned
in and said, ‘‘I head up the effort, and I want to be there with that
team.’’ And here we are today.
So this is not something, Dr. Burgess, that we have just casually
overlooked or ignored. That is far from the fact.
I now would like to recognize the chairman of the full committee,
Mr. Pallone, for his 5 minutes.
Mr. PALLONE Thank you, Chairwoman Eshoo.
OPENING STATEMENT OF HON. FRANK PALLONE, JR., A REP-
RESENTATIVE IN CONGRESS FROM THE STATE OF NEW JER-
SEY
Today’s hearing serves two critical purposes: first, we will exam-
ine the Trump administration’s proposed budget for the Depart-
ment of Health and Human Services for fiscal year 2021, and, sec-
ond, we will get a crucial update on the administration’s ongoing
response to the coronavirus.
I am disappointed, though not surprised, that the Trump admin-
istration budget proposal completely contradicts the healthcare
promises that the President repeatedly makes to the American peo-
ple.
When it comes to ensuring the American people have access to
affordable and quality healthcare, the Trump administration has
failed them, and this budget proposal continues that record.
Two years after showering the wealthy and large corporations
with major tax breaks, the President’s 2021 budget proposal
slashes $100 billion from the Affordable Care Act, $500 billion from
Medicare, and more than $900 billion from Medicaid over the
course of years. And the President also wants to make it easier for
States to take away people’s coverage, undermine their care, and
cut critical benefits.
And this puts the health and well-being of tens of millions of
children, parents, pregnant women, and people with disabilities at
risk. Medicaid is a lifeline for millions of working-class families,
and it is unconscionable that the president wants to cut it to pay
for tax cuts for millionaires.
Now, these budget cuts also fly in the face of President Trump’s
own words. He promised that, as President, he would not cut Medi-
care or Medicaid. And he promised in his State of the Union Ad-
dress earlier this year that he would continue to protect the more
than 130 million Americans with preexisting conditions. But, as
Secretary Azar knows, this administration is now suing in the Fed-
8
eral courts to strike down the ACA and all of its consumer protec-
tions.
Overall, President Trump is proposing a 12-percent cut to the
HHS’s budget, one of the largest cuts to any Federal agency. The
devastating cuts don’t end at Medicare, Medicaid, and the ACA.
The President’s proposal cuts the National Institutes of Health by
$3 billion and the Centers for Disease Control and Prevention by
$675 million. And keep in mind that this is the very agency that
is now responding to the coronavirus.
And I am also concerned by the proposal to move tobacco regula-
tion out of the FDA’s authority altogether. Instead, the administra-
tion would create a new, untested agency to oversee tobacco prod-
ucts while we are in the midst of a youth tobacco epidemic.
After years of regulatory uncertainty, the Tobacco Control Act
clearly and unambiguously ensured that FDA would regulate to-
bacco products for the protection of public health, and, over the last
decade, the agency has worked to develop the expertise, workforce,
and scientific basis to effectively regulate these products.
So I am concerned that this proposal would only serve to further
politicize tobacco regulation by stripping away FDA’s sound, sci-
entific, and evidence-based approach and replacing it at the whims
of political appointees. And it is nothing more than a gift, frankly,
to big tobacco companies.
Now, let me just move to the second topic at hand. After we dis-
cuss the budget, we will ask questions of the Secretary and other
top public health officials on the administration’s efforts to address
the coronavirus outbreak. It is critical that we get an update on the
scale of the outbreak, its repercussions in the U.S., and how we can
work together to ensure the safety of all Americans.
I think we have one of the strongest public health infrastructures
in the world, and it is more than capable of coming to an effective
solution. And we should be supporting that system with all avail-
able resources.
So, again, Madam Chair, I thank you. And I think—well, actu-
ally, I have time left, if anybody wants it, but—everybody gets
time, or should—does anybody want my time? I guess not.
All right. Thanks a lot. I yield back.
PREPARED STATEMENT OF HON. FRANK PALLONE, JR.
Today’s hearing serves two critical purposes. First, we will examine the Trump
Administration’s proposed budget for the Department of Health and Human Serv-
ices for fiscal year 2021. And second, we will get a critical update on the Adminis-
tration’s ongoing response to the coronavirus.
I am disappointed, though not surprised, that the Administration’s budget pro-
posal completely contradicts the healthcare promises that President Trump repeat-
edly makes to the American people.
When it comes to ensuring the American people have access to affordable and
quality healthcare, the Trump Administration has failed them, and this budget pro-
posal continues that sorry record.
Two years after showering the wealthy and large corporations with major tax
breaks, the President’s 2021 budget proposal slashes $100 billon from the Affordable
Care Act (ACA), $500 billion from Medicare and more than $900 billion from Med-
icaid over the course of ten years. The president also wants to make it easier for
states to take away people’s coverage, undermine their care, and cut critical bene-
fits. This puts the health and well-being of tens of millions of children, parents,
pregnant women, and people with disabilities at risk. Medicaid is a lifeline for mil-
9
lions of working-class families, and it’s unconscionable that the president wants to
cut it to pay for tax cuts for millionaires.
These budget cuts also fly in face of President Trump’s own words—promising
that, as president, he would NOT cut Medicare or Medicaid. And promising in his
State of the Union Address earlier this year that he would continue to protect the
more than 130 million Americans with pre-existing conditions. As Secretary Azar
well knows, this Administration is now suing in the federal courts to strike down
the ACA and all of its consumer protections.
Overall, the President is proposing a 12 percent cut to HHS’s budget—one of the
largest cuts to any federal agency. The devastating cuts don’t end at Medicare, Med-
icaid and the ACA, the President’s proposal, cuts the National Institutes of Health
(NIH) by $3 billion, and the Centers for Disease Control and Prevention (CDC) by
$675 million. Keep in mind this is the very agency that is now responding to the
coronavirus.
I’m also concerned by the proposal to move tobacco regulation out of the Food and
Drug Administration’s (FDA) authority altogether. Instead, the Administration
would create a new, untested agency to oversee tobacco products while we are in
the midst of a youth tobacco epidemic. After years of regulatory uncertainty, the To-
bacco Control Act clearly and unambiguously ensured that FDA would regulate to-
bacco products for the protection of public health. Over the last decade, the agency
has worked to develop the expertise, workforce, and scientific basis to effectively
regulate these products. I’m concerned that this proposal would only serve to further
politicize tobacco regulation by stripping away FDA’s sound scientific and evidence-
based approach and replacing it at the whims of political appointees. This is nothing
more than a gift to big tobacco companies.
Now, let me move to the second topic at hand today. After we discuss the budget,
we will ask questions of the Secretary and other top public health officials on the
Administration’s efforts to address the coronavirus outbreak. It is critical that we
get an update on the scale of the outbreak, its repercussions in the United States,
and how we can be working together to ensure the safety of all Americans. We have
one of the strongest public health infrastructures in the world, and it is more than
capable of coming to an effective solution. We should be supporting that system with
all available resources.
Thank you, and I yield back.
Ms. ESHOO. The gentleman yields back.
Pleasure to recognize the ranking member of the full committee,
Mr. Walden, for his 5 minutes for his opening statement.
OPENING STATEMENT OF HON. GREG WALDEN A REPRESENT-
ATIVE IN CONGRESS FROM THE STATE OF OREGON
Mr. WALDEN. Thank you, Madam Chair. Good afternoon.
And, Mr. Secretary, thank you for being here today. It is not the
first time we have seen you here, I think, this year probably, but
certainly, we appreciate the work you and your team have done
dealing with the coronavirus.
I think I have been in every one of the roundtables and hearings
that you and your team have provided for this committee and other
committees. Chairman Pallone and I were the co-moderators of the
first one in the Visitor Center, where every Member of Congress
was invited, and I was at the last one, and I was at the Situation
Room at the White House before the break. And, you know, I think
you all have been very forthcoming with the facts.
And for whatever reason, we haven’t had a hearing here. Maybe
we wanted to wait until this one. But I think it is important that
we hear from you and the team that you are leading.
And I think it is important to recognize the work that Mrs.
Brooks did on reauthorizing the Pandemic and All-Hazards Pre-
paredness Act in the last Congress. We had big fights about that,
but thank goodness it is in place, because it is designed to do ex-
actly what we are encountering today: have a lead person in the
10
administration—that is you—that is designated by the President,
and a team ready to go.
And so I guess I have been to enough of those briefings that I
saw Members kind of yawning at some point in those, quote/un-
quote, ‘‘closed-door briefings’’ because we were hearing it for the
third time.
Now, we were gone a week, and a lot has changed. And we know
what is happening in China is probably worse than we are being
told. And I think the big issues there are the supply chain as well
as public health.
We know it is spreading around the world, and we are trying to
cope. And we know, and you have warned us, and Dr. Fauci has
warned us, and others, expect it to—you know, this could well mu-
tate, but that doesn’t mean end of world. It can well expand; we
should be ready for that. But, as Mr. Pallone said, we have a ter-
rific public health system here in the United States.
A lot of that is driven at the local level. And it is important we
have those communication links in place so that when we identify
something, somebody coming in through an airport, the local health
officials know about it at home and we are able to deal with it. And
I think it is good to get this out in the public.
I would just point-out that we will hear from you and the CDC,
FDA, and ASPR and NIAID to give us an update on the sidecar
hearing. We have had now, what, 80,000 confirmed cases world-
wide, 2,700 deaths. The outbreak has become a significant global
health concern. Yesterday, Italy announced 300 individuals have
been affected by the coronavirus; 11 have died.
There is still much we do not know about the outbreak, and so
we will learn more, I guess, after this budget hearing.
But it is essential that we do everything we can and provide you
the assistance. And I know, in the meetings I have been in with
everybody else on this committee that was there to attend, you
have made it clear, if you need more money, you will ask us, and
we have made it clear, if you need more money, tell us, and we will
work with you.
Now, we will want to get the specifics, obviously, but I know you
have sent up a supplemental request for, I think, a total of a little
over $2 billion, $2.5 billion. Some of that is reprogramming; some
of it is additional money. No sooner had that left your office than
some politicians were on the air, criticizing you for not asking for
enough. And so we will be interested to get your response to that.
I do think it is also essential to look at perspectives in terms of
what Americans are facing today with the traditional flu and that
we have probably lost, what, 10,000 or more Americans have died
from the annual flu. And we have vaccines for that and treatments
for that. And so we have to think about that, as well, and practice
good public health.
I was in Japan with a couple of other of my colleagues on the
committee, and you can’t go anywhere in Japan without the hand
sanitizer being squirted in your hands. And it was a good lesson,
I think, for all of us. But we ought to be doing a little bit more of
that here and we would probably help with the traditional seasonal
flu and spread of other diseases.
11
And so there is a lot we can learn from you; there is a lot we
can learn from your team. And we will look forward to hearing
from you directly on that, on the record here in the public.
So, with that, Madam Chair, I yield back.
[The prepared statement of Mr. Walden follows:]
PREPARED STATEMENT OF HON. GREG WALDEN
Madame Chair, thank you for holding this important hearing. Secretary Azar,
welcome back. Thank you for taking the time to be here today and the work you
and your team continue to do.
Providing funding to essential health programs has been one of the priorities of
this committee. Last year, we passed several important bills that reauthorized re-
search funding for autism and the Emergency Medical Services for Children pro-
gram. We also included provisions in the end-of-the-year spending bill that provide
additional protections for CRT wheelchairs provided to Medicare beneficiaries.
These provisions—that are now law—directly and positively impact the American
people and show we are a committee that can continue to reach bipartisan agree-
ments to help the public.
The President’s budget continues to build on a number of proposals that increase
health access to rural communities, combat the HIV epidemic, and provide states
greater flexibility to engage in innovative programs—such as implementation of the
Money Follows the Person demonstration, giving consumers the choice of where they
live and receive services.
As the opioid epidemic continues to claim lives and other drug epidemics are aris-
ing, the budget also keeps vital grants in the budget for substance use disorder
treatment.
The budget also integrates proposals that members of this committee have pre-
viously supported, such as providing lifetime coverage for immunosuppressive drugs
for kidney transplant recipients as well as an extension of the Independence at
Home demonstration program. These are good, bipartisan proposals that continue
to build on the work this committee has done.
The budget also reiterates the President’s commitment to providing greater price
transparency, so patients know the cost of their services. Additional provisions re-
move regulatory barriers that hinder the ability to have more value-based care, such
as modernizing the Stark Law and making site-neutral payment changes so that
costs can be uniform for all Medicare beneficiaries.
It should also be noted that we are quickly approaching the May 22nd deadline
to fund community health centers and other essential programs for the rest of the
year. These are important programs and we need to make sure they are fully fund-
ed; it’s also an opportunity to act on legislation to end surprise medical bills - a key
priority of not only this committee, but also President Trump. Of course, the Presi-
dent’s budget also emphasizes the need to engage in drug pricing reform to lower
the cost of prescription drugs for consumers. I hope that we can work on bipartisan
proposals that will do so and I continue to believe the Lower Costs, More Cures Act,
that I introduced, has a path to the President’s desk. This would provide savings
to the American people, place the first out-of-pocket cap on America’s seniors’ drug
costs, and prioritize innovation without sacrificing lifesaving cures—unlike Speaker
Pelosi’s alternative with estimates that up to 15 or even 100 fewer cures would be
developed.
After we hear from Secretary After we hear from Secretary Azar, we’re going to
hear from representatives of the CDC, FDA, NIAID, and ASPR to give us an update
on the coronavirus outbreak and responses to combat it. I thank Doctors Redfield,
Hahn, Fauci, and Kadlec for taking the time to appear before us today. With over
80,000 confirmed cases and over 2,700 deaths, the outbreak has become a significant
global health concern. Yesterday, Italy announced over 300 individuals had been af-
fected by the coronavirus and 11 had died. There is still much we do not know about
the outbreak given that public health authorities have been given limited access to
Chinese patients. It is important to make sure that the CDC and other agencies
have the necessary funding to further research and manage this outbreak. Earlier
this week, the Administration requested emergency funds to combat the coronavirus
outbreak and I think this Committee should do everything it can to assist public
health officials with this crisis.
I thank both panels for taking the time to appear and I look forward to hearing
from each of you.
12
Ms. ESHOO. The gentleman yields back.
I now would like to introduce our witness for today’s first panel.
One person, one person alone: the Nation’s Secretary of Health and
Human Services.
Welcome to you, Secretary Azar. You certainly are familiar with
the lighting system around here, so you are now recognized for 5
minutes for your statement to the committee. Thank you for being
here.
STATEMENT OF ALEX AZAR
Secretary AZAR. Great. Thank you very much.
Chairwoman Eshoo, Chairman Pallone, Ranking Members Wal-
den and Burgess, thank you for inviting me to discuss the Presi-
dent’s budget for fiscal year 2021.
I am honored to appear before the committee for budget testi-
mony as the HHS Secretary for the second time, especially after
the remarkable year of results that the HHS team has produced.
With support from this committee, this past year, we saw the
number of drug overdose deaths decline for the first time in dec-
ades, another record year of generic drug approvals from FDA, and
historic drops in Medicare Advantage, Medicare Part D, and Af-
fordable Care Act exchange premiums.
The President’s budget aims to move toward a future where
HHS’s programs work better for the people we serve, where our
human services programs put people at the center, and where
America’s healthcare system is affordable, personalized, puts pa-
tients in control, and treats them like a human being and not like
a number.
HHS has the largest discretionary budget of any nondefense de-
partment, which means that difficult decisions must be made to
put discretionary spending on a sustainable path.
The President’s budget proposes to protect what works in our
healthcare system and make it better. I will mention two ways that
we do that: first, facilitating patient-centered markets; and, second,
tackling key, impactable health challenges.
The budget’s healthcare reforms aim to put the patient at the
center. It would, for instance, eliminate cost-sharing for
colonoscopies, a lifesaving preventive service. We would reduce pa-
tients’ costs and promote competition by paying the same for cer-
tain services regardless of the setting.
The budget endorses bipartisan, bicameral drug pricing legisla-
tion. And I want to thank this committee for your bipartisan work
to pass legislation such as the CREATES Act to cut patient costs
and save taxpayer dollars through lower drug prices.
The budget’s reforms will improve Medicare and extend the life
of the Hospital Insurance Fund for at least 25 years.
We propose investing $116 million in HHS’s initiatives to reduce
maternal mortality and morbidity. And we propose reforms to tack-
le America’s rural healthcare crisis, including telehealth expan-
sions and new flexibility for rural hospitals.
The budget increases investments to combat the opioid epidemic,
including SAMHSA’s State Opioid Response Program. This success-
ful grant program grew out of this committee’s creation of the State
Targeted Response grants in the Cures Act, and we were pleased
13
to work with Congress to provide flexibility on the SOR grants for
States to address stimulants like methamphetamines.
We request $716 million for the President’s initiative to end the
HIV epidemic in America by using effective, evidence-based tools.
Thanks to support from Congress, we have already begun imple-
mentation of the initiative.
The budget reflects how seriously we take the threat of other in-
fectious diseases, such as the novel coronavirus, by prioritizing the
funding for CDC’s infectious disease programs and maintaining in-
vestments in hospital preparedness.
As of this morning, we still had only 14 cases of the novel
coronavirus detected in the United States involving travel to or
close contacts with travelers. Coming into this hearing, I was in-
formed that we have a 15th confirmed case, the epidemiology of
which we are still discerning. Three cases also exist among Ameri-
cans repatriated from Wuhan, and 42 cases exist among American
passengers repatriated from the Diamond Princess cruise ship in
Japan.
While the immediate risk to the American public remains low,
there is now community transmission in a number of countries, in-
cluding outside of Asia, which is deeply concerning. We are work-
ing closely with State, local, and private-sector partners to prepare
for mitigating the virus’s potential spread in the United States, as
we expect to see more cases here.
On Monday, OMB sent a request to make at least $2.5 billion in
funding available for preparedness and response, including for
therapeutics, vaccines, personal protective equipment, State and
local public health department support, and surveillance. I look for-
ward to working closely with Congress on that proposal.
This year’s budget aims to protect and enhance Americans’ well-
being and deliver Americans a more affordable, personalized
healthcare system that works better rather than just spends more.
I look forward to working with this committee to make that com-
monsense goal a reality.
Thank you very much.
[The prepared statement of Secretary Azar follows:]
14
PREPARED STATEMENT OF MR. AZAR
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27
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Ms. ESHOO. Thank you, Mr. Secretary.
And we will now move to member questions. And I will recognize
myself for 4 minutes, which will be the limit for questions to the
Secretary.
Mr. Secretary, we know that on February 24, the Acting Director
of OMB—what was requested, the appropriation of $1.25 billion for
emergency funding for the virus. Is that what you requested of
OMB?
Secretary AZAR. So the actual total supplemental authorization
would be $2.5 billion. We proposed——
Ms. ESHOO. That I know, but——
Secretary AZAR [continue]. Half of that to be covered——
Ms. ESHOO [continue]. The new funding is 1.25.
Secretary AZAR. I do want to emphasize, as I have told the ap-
propriators, that was meant as a suggestion of a way to fund half
of it. But if Congress decides there are other approaches, we are
not wed to that.
Ms. ESHOO. And what exactly does that cover? And is it antici-
patory?
Now, yesterday, the CDC said we need to be prepared—essen-
tially, we need to be prepared for a much larger spread of this
virus in the United States. So is what has been requested in emer-
gency funding to cover a broader plan, or is it on the figures that
you just gave us?
Secretary AZAR. So it is to cover expenses that we believe are ap-
propriate for 2020. So this would go through the end of 2020’s fiscal
year. And then we would work with appropriators on any adjust-
ments to 2021 appropriations in the weeks and months ahead as
we continue to learn on a daily basis about the spread of the dis-
ease.
Core investments. First, surveillance, expanding our surveillance
system for novel——
Ms. ESHOO. Yes. I have some other questions, so——
Secretary AZAR. Oh, sure. But——
Ms. ESHOO. All right.
Secretary AZAR [continue]. I am happy to walk you through the
five key basic——
Ms. ESHOO. And I read the entirety of your printed statement.
I want to turn to the status of drug pricing policy proposals. If
you could just say ‘‘yes’’ or ‘‘no,’’ it would be great.
Have you finalized a policy ending drug rebates to middlemen in
Medicare?
Secretary AZAR. We did not move finally with that rule.
Ms. ESHOO. OK.
Have you finalized a policy tying drug prices to the lower costs,
the reference pricing?
Secretary AZAR. We had an advance notice of proposed rule-
making, so that was not an actual formal proposal yet.
Ms. ESHOO. All right.
Have you finalized a proposal to make drug manufacturers put
list prices in television advertisements?
Secretary AZAR. We did. And much to their shame, the pharma
industry sued. And Congress has not passed explicit authorization
32
for that list price requirement in the statute that I wish they would
do.
Ms. ESHOO. Are you planning to finalize or pursue any of these
policies in the near future?
Secretary AZAR. We plan to finalize as soon as we can the impor-
tation program implementing section 804 of the Food, Drug, and
Cosmetic Act to allow low-cost importation from Canada.
Ms. ESHOO. You know that the House passed H.R. 3. You also
know that the President said that we are going to ‘‘negotiate, nego-
tiate, negotiate so hard,’’ or something like that. ‘‘We are going to
negotiate like crazy.’’ Do you support direct negotiations?
Secretary AZAR. We do not support H.R. 3 because we don’t be-
lieve the negotiation framework in there is either a negotiation or
actually practical and implementable. And it also just has no
chance of passing in the Senate. The bipartisan package of Grass-
ley-Wyden is struggling even to get to the floor there.
Ms. ESHOO. Well, H.R. 3 caps out-of-pocket, as you know, pre-
scription costs for seniors. Do you support the capping of out-of-
pocket costs for them?
Secretary AZAR. We have an important opportunity here——
Ms. ESHOO. Yes or no?
Secretary AZAR [continue]. Bipartisan——
Ms. ESHOO. Yes or no?
Secretary AZAR [continue]. To cap out-of-pocket spending and re-
duce what seniors——
Ms. ESHOO. Yes or no?
Secretary AZAR [continue]. Are you paying for Part D. So, yes, we
do.
Ms. ESHOO. OK. Good.
Well, I think that I have asked all—let me just—well, H.R. 3 also
limits drug price hikes to inflation. Do you support the inflation
caps?
Secretary AZAR. So that is part of the Grassley-Wyden package
also in the Senate, and we——
Ms. ESHOO. Do you support it?
Secretary AZAR [continue]. Have made clear that that is a pack-
age we can support it. It is not the only bipartisan package, but
the price inflation penalties in Part D and B are acceptable to us
as a means of getting list prices under control.
Ms. ESHOO. Thank you.
My time has expired. I now would like to recognize the ranking
member of the subcommittee for his 4 minutes of questions.
Mr. BURGESS. Thank you.
Mr. Secretary, in December of 2018, the President signed two im-
portant bills into law that addressed maternal health and maternal
mortality. The first bill, Representative Jaime Herrera Beutler’s
Preventing Maternal Deaths Act, established a grant program for
States to establish or expand maternal mortality review commit-
tees. The other bill, Improving Access to Maternity Care Act, re-
quired HRSA to identify maternity care health professional target
areas.
So how have you used these bills? How is your agency building
on the success of those two laws to ensure access to quality mater-
nity care and prevent maternal mortality?
33
Secretary AZAR. First, could I thank you for your leadership on
immunosuppressive drugs? I hope you saw that we put in the
budget what you have long advocated for in terms of that coverage.
On this——
Mr. BURGESS. Yes. Yes, you may say thank you. You are wel-
come.
Secretary AZAR. And on maternal mortality also, the work of
Congress really focusing on this critical issue. Too many women are
dying either in childbirth, preterm, at childbirth, or postpartum.
And so we have made this a serious part of the President’s agenda,
with a $116 million initiative, with the $74 million increase, that
focused on improving prevention, quality improvement, postpartum
health, and improving the data collection on that, so a four-part
strategy that we look forward to working with Congress on coming
out of the budget.
Mr. BURGESS. Well, I thank you for that.
You know, Republicans on this subcommittee in 2017 sent your
predecessor, Secretary Price, a letter asking for HHS to update and
release the Pandemic Flu (Influenza) Plan. And it previously had
not been updated since 2005.
Can you describe how you are using the Pandemic Influenza
Plan as a guide in preparing for your response to this current out-
break of the coronavirus?
Secretary AZAR. So, as you know, I was one of the architects of
the original pandemic plans back in the Bush administration. That
work is foundational. That is what has set up our entire State,
local, and Federal preparedness program for any type of viral out-
break like this.
And so it is really the blueprint for how we are operating today,
including my role, leading through the Emergency Support Func-
tion 8 under the National Response Plan, which is the doctrine
that we have had in place now for 15 years.
Mr. BURGESS. Let me just say, this committee did do work on
H.R. 3 last October. There was concern from many of us that the
negative effects on innovation and development would really be
profound. And now we find ourselves confronted with this
coronavirus outbreak, where we know we need new antivirals, we
know we need new vaccines, we know we need new monoclonal
antibodies to help people who become ill.
Can you just speak to the fact of, is innovation still important?
Because we have heard several times in this subcommittee and in
the full committee that maybe innovation wasn’t so important as
getting cheaper drugs into people’s hands.
Secretary AZAR. Innovation is vitally important, and that is why
two of the key legs of the supplemental request are to develop vac-
cines and therapeutics for this novel virus.
One of the challenges with H.R. 3 is the sheer amount of money
it would pull out of the system. And I am not a believer that if you
pull any money out of the drug industry——
Mr. BURGESS. Right.
Secretary AZAR [continue]. It is catastrophic or impossible. But
the sheer amount would materially impact the bringing forward of
drug therapies for Alzheimer’s, for arthritis—just go through the
list of therapies that you need to incent, or you won’t get them.
34
Mr. BURGESS. Yes. And, you know, interestingly enough, the Alz-
heimer’s drug that was withdrawn a year ago, I am reading, is now
getting a new look at different dosing schedules. And, again, work
like that, that is not going to happen if we don’t value innovation.
Mr. Secretary, I thank you for being here and certainly look for-
ward to the second part of this hearing.
I yield back.
Ms. ESHOO. The BARDA biodefense budget has also been cut.
Now, glad to recognize the chairman of the full committee for his
4 minutes of questions.
Mr. PALLONE. Thank you, Chairwoman Eshoo.
Mr. Secretary, I thank you for appearing before our sub-
committee today. But I continue to be upset by the Trump adminis-
tration’s decision to ask the court to strike down the ACA in the
Republican lawsuit that is seeking to declare the entire law invalid.
If the district court ruling is upheld, then the Trump administra-
tion will be responsible for the largest coverage loss in U.S. history.
Over 20 million Americans would lose their coverage, raising con-
sumer costs and making lifesaving healthcare unaffordable for
American families. And it would eliminate protections for pre-
existing conditions, adversely impact the Medicare program, and
end Medicaid expansion.
So I have sent you three letters now, including one in April of
last year, requesting any analysis, study, assessment, or reports re-
garding the potential impact if the entire ACA is found to be un-
constitutional. And for almost two years now, I have repeatedly
asked for any documents relating to any contingency plans in place
in the event the ACA is found unconstitutional.
Only last week, I received a 1- and 1.5-page response that an-
swers none of my questions, frankly. And the documents produced
so far to the committee answer none of these questions.
So I would like to submit, Madam Chair, my letters and the De-
partment’s response in the record. I would ask for unanimous con-
sent.
Ms. ESHOO. So ordered.
[The information appears at the conclusion of the hearing.]
Mr. PALLONE. So, really—I have 2.5 minutes here, Mr. Sec-
retary—I think the American people have the right to know what
the administration’s contingency plans are, given the President is
asking that this entire law be declared invalid. Maybe you just
have to answer ‘‘yes’’ or ‘‘no.’’ We will see. I only have two minutes.
Secretary, has the Department conducted an analysis to evaluate
the impact on individuals with preexisting conditions and their ac-
cess to affordable health insurance if the ACA is found unconstitu-
tional, yes or no?
Secretary AZAR. Well, of course, it is not going to be left just like
that. We would replace it with something that would actually deal
with preexisting conditions——
Mr. PALLONE. But have you done any kind of contingency plans
for what would happen if the court struck down the ACA, yes or
no?
Secretary AZAR. We are always considering different options, but
it will depend on the nature of any ultimate court decision——
Mr. PALLONE. All right.
35
Secretary AZAR [continue]. If it even agrees with striking down
all or part of the ACA.
Mr. PALLONE. All right. Well, it doesn’t sound like there is such
a thing.
Has the Department conducted an analysis to evaluate the im-
pact on premiums and access to coverage in the individual market,
particularly for individuals with preexisting conditions, if the ACA
is found unconstitutional, yes or no?
Secretary AZAR. Well, it depends on what would be struck down,
whether all of it is struck down, part of it, or none of it.
Mr. PALLONE. OK.
Secretary AZAR. We are years, possibly, away from a final court
decision on all of these elements.
Mr. PALLONE. All right. Well, let me ask you this. Are there any
contingency plans to ensure that the 20 million people who are cov-
ered under the ACA do not lose coverage? Anything at all? Any
contingency plans?
Secretary AZAR. Well, first, we have been emphatic that we are
changing nothing about how we administer this program during
the pendency of the litigation. And at the time that there—if there
is a final court decision striking down all or part of it, it will de-
pend on the context of that decision and the politics, frankly, of
who is in Congress and what we can work with to ensure the——
Mr. PALLONE. Well, I am trying to——
Secretary AZAR [continue]. Protection of preexisting conditions.
Mr. PALLONE. It sounds like the answer is, no; you don’t have
anything yet.
I would just like a commitment from you, basically, to respond
to my request to provide any documents to the committee that re-
late to contingency plans in the event that the ACA is struck down.
Can you give me that commitment?
Secretary AZAR. I am sure you will understand that deliberative
processes regarding potential legislative proposals are some of the
core of the internal executive departments’ functions.
Mr. PALLONE. So it sounds like the answer is no. Well, I just
think that it is unfortunate because, you know, our oversight re-
sponsibility is to make sure that, in the event we have this terrible
situation, that there is some kind of contingency plan. And I don’t
think you have it. So I don’t believe the administration has any
kind of comprehensive plan to address the fallout that will occur
if this Republican suit is successful in court.
Thank you, Madam Chair.
Ms. ESHOO. The gentleman yields back.
The Chair recognizes the ranking member of the full committee,
Mr. Walden, for his 4 minutes.
Mr. WALDEN. Thank you, Madam Chair.
Mr. Secretary, again, thanks for being here.
I want to make a couple of points.
One is, on the opening day of this Congress, I led the effort on
the House floor, now in the minority, trying to move an effort to
protect people with preexisting conditions pending this lawsuit’s
decision.
Congress could act. This House could move legislation to put into
law certainty to protect people with preexisting conditions, in addi-
36
tion to the laws that are already on the books dealing with pre-
existing conditions. But my colleagues have chosen not to do that.
So they could. And we would probably find common ground here
on a preexisting severability language. There is a lot that could be
done here.
Second, it was the Congressional Budget Office—independent,
nonpartisan—that said, I believe 8 to 15 new medicines would
never be invented because of H.R. 3, Speaker Pelosi’s partisan drug
pricing bill. As you said, that could be a cure for Alzheimer’s. It
could be a cure for the coronavirus. We don’t know.
And that is just the first ten years. The further out you look, the
more future innovation will be lost. California Life Sciences said
upwards of 85 percent of what they invest in would go away.
Eighty thousand U.S. jobs, 80,000 is what California Life Sciences
said. We would lose the R&D. We would lose the innovation.
Now, no President that I have been around, Republican or Demo-
crat, has ever leaned in harder on these issues of cost of care than
President Trump. And I was with you and him when he announced
the effort to get transparency in the hospital system. And before we
got from the news conference to the Oval Office, I believe the hos-
pitals had sued you. Is that correct?
Secretary AZAR. I believe it is, yes.
Mr. WALDEN. Yes.
And you talked about the drug disclosure in advertising. And
what happened there?
Secretary AZAR. Rather disgustingly, the pharmaceutical indus-
try sued us to conceal their list prices from their consumers.
Mr. WALDEN. And so then I want to talk about Medicare Part D.
We were all working together on this committee, which we have a
great reputation of doing—occasionally we fight, and that is all
right; we know it. But we were working together to cap the out-
of-pocket costs for seniors under Medicare Part D and modernize
Medicare Part D when all that, unfortunately, came to an abrupt
halt, driven, I am going to say, from the Speaker’s office. Those dis-
cussions ceased.
But we agreed that we needed to cap out-of-pocket costs. We put
that in our bill, H.R. 19. They put that in their partisan H.R. 3.
But we all agree that it is time to cap the out-of-pocket costs for
seniors in Medicare.
Does the administration support capping the out-of-pocket costs
for seniors in Medicare?
Secretary AZAR. Absolutely.
Mr. WALDEN. Did the administration opposes H.R. 3?
Secretary AZAR. We do oppose H.R. 3.
Mr. WALDEN. Did the administration support the concepts of
H.R. 19, our alternative?
Secretary AZAR. We support the elements of it, absolutely, includ-
ing the notion of capping out-of-pockets and saving seniors money.
Mr. WALDEN. One of the big issues we have dealt with here, or
tried to, is the high cost of insulin, not just for seniors but for oth-
ers. But in our alternative, H.R. 19, that was all bipartisan legisla-
tion, we capped cost of insulin, I believe, at $50 a month was the
maximum.
Does the administration support that concept?
37
Secretary AZAR. I believe so, yes.
Mr. WALDEN. So, going forward, are you hopeful that Congress
and the administration can get together on a plan the President
can sign, that can become law, that would actually reduce the costs
of pharmaceutical drugs in America without driving innovation
away?
Secretary AZAR. Yes. I have said the administration is the most
flexible party here—Republicans, Democrats, Senate, House. Get
list prices under control, lower out-of-pockets, and give the drug
plans the real incentive to get drug prices down.
Mr. WALDEN. H.R. 19 contains about 80 or 90 percent of the
Wyden-Grassley bill. We think we are with you, we think we can
get there, if we can just put the partisan weapons away.
Thank you, Mr. Secretary.
And I yield back.
Ms. ESHOO. The gentleman yields back.
Pleasure to recognize the gentleman from New York, Mr. Engel,
for his 4 minutes of questions.
Mr. ENGEL. Thank you, Madam Chair.
Secretary Azar, the State of New York was extremely dis-
appointed to hear that CMS has denied the State’s request for a
renewal of its Delivery System Reform Incentive Payment Pro-
gram, known as DSRIP.
When the program was first approved, CMS and HHS insisted
that New York include targets for the State’s Medicaid program
that would incentivize providers to move away from fee-for-service,
toward value-based payments.
New York’s healthcare community has made progress in doing
just that, receiving double-digit reductions in preventable hospital
readmissions, while saving the Federal Government billions of dol-
lars.
The request for additional time and continued investment of
those savings in DSRIP was to move closer to exactly what CMS
and HHS have been saying the Federal Government wants every-
one to be doing. So, in light of that, why would CMS and HHS
want to stop supporting these successful efforts to achieve the very
goals that the Trump administration has been saying that it has
for healthcare?
So will your department commit to meeting with the State of
New York to discuss how these reforms are sustained into the fu-
ture? And I would like a ‘‘yes’’ or ‘‘no’’ answer if I could get it.
Secretary AZAR. Yes. I am not familiar with that particular pro-
gram, but you are right, we do support value-based transformation
in our programs. I don’t know the particulars of why CMS has had
difficulty with New York, but, yes, we will be happy to sit with
New York.
Mr. ENGEL. OK. And I would be happy to sit with you as
well——
Secretary AZAR. Thank you.
Mr. ENGEL [continue]. And discuss it.
Mr. Secretary, we have mentioned it here, other members have
mentioned it here, and you know it far too well, that Americans are
suffering from the current epidemic of skyrocketing prescription
drug prices. My constituents always tell me they are having to
38
make unconscionable choices between paying for food or filling a
lifesaving prescription such as insulin.
The House has taken bold, decisive action to lower drug prices
through H.R. 3, which provides a commonsense solution to this cri-
sis by allowing the government to negotiate drug prices. That is a
policy that the President supported as a candidate in 2016, say-
ing—and I quote—‘‘When it comes time to negotiate the cost of
drugs, we are going to negotiate like crazy,’’ unquote. That is from
the President.
The administration has yet to deliver any meaningful solutions
for the health crisis. In May 2018, your Department released a
blueprint to lower drug prices, but many of those policies failed to
materialize or provide minimal relief to patients. Other ideas, such
as the International Pricing Index, have been shelved.
Despite these failures, President Trump claims to have reduced
drug prices, when, in fact, a recent report showed that, on average,
drug prices increased by over five percent at the start of this year.
Mr. Secretary, can you commit to me today that you will deliver
on the President’s promise to negotiate drug prices? I would like
a ‘‘yes’’ or ‘‘no’’ also.
Secretary AZAR. So we support bicameral, bipartisan legislation
that would get through. And there are many principles in H.R. 3
the President is supportive of, but it has to pass both houses of
Congress, and, at the moment, H.R. 3 doesn’t have a chance of see-
ing the light of day in the Senate. And so we need to work together
to see if something can get through both chambers.
Mr. ENGEL. Well, I am sure if the President asked Mitch McCon-
nell to put it on the agenda, he would.
Secretary AZAR. I don’t think so.
Mr. ENGEL. There are plenty of things that we have passed in
this House that, unfortunately the other body hasn’t done, and the
President seems to be right along with it.
So I just think it is another example of the administration’s bro-
ken healthcare promises to the American people. I just think that
we need to get those prices of drugs down, and we need to have
not empty rhetoric but true facts.
And I yield back the balance of my time.
Ms. ESHOO. The gentleman yields back.
Pleased to recognize the gentleman who was the former chair-
man of the full committee, Mr. Upton of Michigan, for his 4 min-
utes.
Mr. UPTON. Thank you, Madam Chair.
Mr. Secretary, welcome. Big time.
So, as you know, this committee, on a unanimous vote, passed
21st Century Cures—‘‘Cures,’’ as we call it. When I was chair, we
expedited the approval of drugs and devices, and I would suspect
strongly that your testimony that we had a record number of ge-
neric approvals is a direct result because of what this committee
did.
We also added some $45 billion in health research over a 10-year
span. And, frankly, we asked the question of the agencies, as we
worked on this legislation, what is it that we could do to help you
make sure that we hit these targets of faster approvals of drugs
39
and devices. And so, whether it was the FDA, the CDC, and others,
the NIH obviously, they gave us an answer, and we delivered.
And at the end of the day, for this crisis, we are going to find
a vaccine to solve coronavirus. I know that we are. And I would
like to think that what we did in this committee and then passed
on the House floor will be a direct result of that.
And, frankly, it prompts all of us, I think, to ask the questions
of what more can we do to get on a faster pace to find that vaccine
and that cure. And, in fact, as you may know, Diana DeGette and
I are again working on a 2.0 Cures bill, where we can take these
three years since President Obama signed the bill into law and ask
those questions to see what, constructively, we can do so that all
hands are on deck. And I know—I don’t have to ask you—I know
that you will help us with ideas to do that.
A question that I have is: A containment is the very first step
in responding to any outbreak of coronavirus. We have seen that
around the world now. And statements from yesterday indicate
that the CDC said it really isn’t if but when it gets to larger num-
bers here in the United States.
I have always believed in the adage that if you are going to do
something, you better do it right the first time because you are not
going to find a second. And you want to make sure that—pay me
now or pay me later. So we need to have the right numbers as it
relates to fighting this terrible disease.
Is the $2.5 billion, is that a floor? Is that a suggestion, the $2.5
billion that you requested?
Secretary AZAR. We have described the request as at least $2.5
billion for 2020 money and then work on 2021 money as we see the
situation develop over the weeks and months ahead.
Mr. UPTON. So I know that we are waiting to see the precise de-
tails of where it is going. Are any of those dollars envisioned to in-
clude the contingency of what China has done as it relates to re-
gional quarantines?
Secretary AZAR. No, we don’t envision that as a, kind of, practical
step here in the United States. As Dr. Messonnier spoke about yes-
terday, in the event that we had community-level outbreaks, which
might be small, just a town, a city, if we had that, we would take
the pandemic playbook, which is community-based mitigation
steps, social distancing.
It is very rare that those types of—that ‘‘cordon sanitaire’’ efforts
around cities are effective. They usually promote more panic and
cause people to actually leave and spread.
Now, China is a different government and culture than we have
here.
Mr. UPTON. Of the 14,000 Americans that have died this flu sea-
son, do you know what percentage of those were not vaccinated?
Secretary AZAR. I do not have the numbers. Historically, our
youth who die tend to not to have been vaccinated, which is a real
tragedy.
Mr. UPTON. And last question: Has there been any query of those
55 Americans who currently have been diagnosed with the
coronavirus—did any of them have the flu vaccine, do you know?
Was that question asked of any of the 55?
40
Secretary AZAR. I don’t know that that would have been asked.
We don’t, of course, have any evidence that the flu vaccine would
have any properties related to the novel coronavirus. But I don’t
know if that was asked as part of the intake for the patients.
Mr. UPTON. OK.
I yield back.
Ms. ESHOO. The gentleman yields back.
It is a pleasure to recognize the gentlewoman from California,
Ms. Matsui, for her 4 minutes of questions.
Ms. MATSUI. Thank you, Madam Chair, for holding this impor-
tant hearing.
And welcome, Mr. Secretary.
Before I get into my line of questioning, I do want to express my
deepest concerns about the Medicare, Medicaid, and other cuts in-
cluded in the budget. At a time when we are dealing with the
coronavirus outbreak, an addiction crisis, and a lawsuit that
threatens ACA protections for preexisting conditions, the adminis-
tration’s cuts to critical safety-net programs target the most vulner-
able in our communities and aim to further erode access to vital
healthcare services.
We should be prioritizing primary comprehensive care, particu-
larly in the mentally ill and people with addiction. I believe mental
health is the area where we have an opportunity to work together
and make progress.
Mr. Secretary, I appreciate the Department’s strong support of
the Certified Community Behavioral Health Clinic Medicaid dem-
onstration. As you know, Representative Markwayne Mullin and I
are working to further scale the program with our bipartisan legis-
lation, the Excellence in Mental Health and Addiction Treatment
Expansion Act.
For the eight States currently participating in the Excellence
demonstration, we have studies showing that quality mental health
services, outpatient care, and addiction treatment provided at these
facilities are saving lives and money. People are avoiding jails and
emergency rooms; instead, getting the comprehensive care they
need in their communities.
We have 11 additional States that are ready to participate in an
expanded Excellence program. Our bill has a bipartisan group of 88
cosponsors who support this full expansion, and the House has al-
ready voted to extend the program longer-term.
I was very pleased to see that the budget this year explicitly en-
dorses extending this Excellence demonstration. And I believe we
do all agree, Mr. Secretary, that adequate Medicaid resources
around substance abuse treatment are essential to fighting the
opioid and addiction epidemic.
Mr. Secretary, I have a question: Under the leadership of Chair
DeLauro, $200 million was made available to HHS in fiscal year
2020 to help States prepare for eventual participation in the Excel-
lence demonstration. How does HHS plan to obligate these re-
sources?
Secretary AZAR. First, thank you for your personal leadership on
the Certified Community Behavioral Health Clinic issue. You are
right, the data is showing really positive results today, so thank
you for that.
41
In terms of your work with Chairwoman DeLauro, SAMHSA is
now accepting applications from States for these grants to increase
access to and improve the quality of community mental and sub-
stance use disorder treatment services through the expansion of
CCBHCs, and the deadline for States to apply is March 10.
Ms. MATSUI. OK. Thank you. The positive impacts of the dem-
onstration make it clear that there is room to improve mental
health and addiction care in this country by scaling this program.
In California, our county hospitals, public academic medical cen-
ters, and public children’s hospitals rely upon financial arrange-
ments that leverage public funds and partnerships as essential
means of providing healthcare to the most underserved commu-
nities and patient populations in the State.
I have concerns about the administration’s recent proposal to
eliminate these sources of funding, particularly supplement pay-
ments. I worry that, if finalized, the Medicaid accountability rule
would destabilize the whole system of care provided under Medi-
Cal. Medicaid supplemental payments are an integral component of
total Medicaid reimbursement that providers rely on for adequate
reimbursement and financial stability.
Mr. Secretary, have you weighed the restrictions on supple-
mental payments against the adequacy of these base payments?
Are there plans to make any corresponding adjustments to base
payments for these providers?
Secretary AZAR. So we are hearing the very important feedback
from you and others about that regulation, and we want to take
that in as we look at how and whether to finalize at CMS the rela-
tionship of these intergovernmental transfers to supplemental pay-
ments and, also, if there are ways we can work with States to re-
structure payments in a way that would be consistent with the law.
So we want to work with the States, not be adversarial to them,
on this.
Ms. MATSUI. OK. Well, thank you, Mr. Secretary.
And I yield back.
Ms. ESHOO. The gentlewoman yields back.
Pleasure to recognize Mr. Shimkus of Illinois for his 4 minutes
of questions.
Mr. SHIMKUS. Thank you, Madam Chairman.
Thank you, Mr. Secretary, for being here.
Coronavirus is a novel pathogen, as a lot of us know, but in your
testimony you also mention emerging microbial threats.
And, Madam Chairman, I ask to submit in the record this news
release from the World Health Organization on the 17th of January
2020.
Ms. ESHOO. So ordered.
[The information appears at the conclusion of the hearing.]
Mr. SHIMKUS. And in the 114th Congress, I joined with Gene
Green on what we called the ADAPT Act. Last Congress, it was
Tony Cárdenas and I, with the help of the now-chairman of the
subcommittee, Anna Eshoo, who joined, and technical assistance by
HHS, on what we call the REVAMP Act. And it is an attempt to
address how, if you have this antimicrobial resistance, how public
funding may not be the only way you can address this.
Can you talk about that challenge?
42
Secretary AZAR. Yes, I am very concerned about the drug devel-
opment around antimicrobial resistance in terms of creating a sus-
tainable market.
You know, we have had, actually, tremendous success from the
efforts you have led and the Congress has led and BARDA at my
agency have supported. We have supported the development of 16
novel antibacterial projects. I believe three have actually come to
market.
What we are finding, though, is there is a market failure ques-
tion here, where you are basically asking a company to develop a
drug but then not to have it used much. And that is not a usually
sustainable business model.
So I have actually commissioned my team to work on how we can
possibly solve that; is that more like a bioterrorism chemical coun-
termeasure and the approaches that we need there. Quite con-
cerned about this.
Mr. SHIMKUS. And that is what we have tried to do legislatively,
and, at sometime, one was the tradeable vouchers debate, which I
think should have legs, especially in this concern of, as you put it,
trying to have something on the shelf that you don’t want to use.
That is the key.
Scott Peters and I are also working on legislation that we call
Ending the Diagnostic Odyssey. And it is an attempt to help DNA
sequencing so that when there is a disease or some event you don’t
have to test, test, test; you can go just through the sequencing as-
pect of that.
Do you have any thoughts on or comments of what you all may
be doing that we don’t know about in trying to push more DNA
identification?
Secretary AZAR. So I have not studied that particular issue. We
are happy to get back to you on that. It certainly is at the fore
right now as we deal with novel coronavirus and have the CDC di-
agnostic, but also hope that commercial innovators will develop
physician bedside diagnostics for rapid insight testing.
Mr. SHIMKUS. Yes. And this is timely—well, it obviously is timely
because of the threat that we are all concerned about now, but it
is also Rare Disease Week. And a lot of that community is, you
know, looking for this as a novel way, especially on what we call
that diagnostic odyssey. And we see that with people who are
struggling with just types of cancer and trying to identify the right
treatment early versus what I would say sometimes is a trial-and-
error method that is very damaging to the health of the patient.
And with 30 seconds left, I wanted to just briefly—and it has
been asked a little bit before. You all do support Medicare D re-
form; is that correct?
Secretary AZAR. Oh, absolutely. It is a real opportunity for sen-
iors.
Secretary AZAR. Well, you would cap catastrophic payment, the
limit at $3,100. So a patient would never pay more than $3,100.
And then, at least the Grassley-Wyden plan, the senior could actu-
ally opt into a program where they would pay no more than $258
a month for their drugs, no matter what their expenses are.
Ms. ESHOO. The gentleman yields back.
43
The gentleman from Maryland, Mr. Sarbanes, is recognized for
his four minutes of questions.
Mr. SARBANES. Thank you, Madam Chair.
Secretary Azar, you certainly know that the popularity of e-ciga-
rettes has recently led to an unprecedented surge in youth tobacco
use, and it is bringing back a vengeance the tobacco epidemic in
this country we have worked so hard to curb. It shows why we
have to improve the law and something this committee has been
working on.
Unfortunately, the Trump administration is now proposing, as I
understand it from the budget, removing FDA’s oversight of tobacco
products in favor of an untested agency that will take years to get
off the ground, which threatens to set us back even further. I am
perplexed that the administration would decide to do this, remove
FDA’s authority, alter the agency’s public health mission, which in-
cludes making, quote, ‘‘tobacco-related death and disease’’ part of
America’s past, not America’s future, and by doing so, ensuring a
healthier life for every family.
This latest move is kind of breathtaking. It makes no sense. It
is a crazy thing to do by the administration, which unfortunately,
hasn’t taken significant action against big tobacco as more of our
Nation’s youth are becoming addicted.
In January, after heavy lobbying from big tobacco, as we under-
stand it, and the vaping industry, and listening to partisan political
consultants like Trump campaign manager Brad Parscale, the ad-
ministration reversed course. We were on a trajectory where we
thought everybody was on the same page.
The administration reversed course, and announced a policy
which failed to ban all flavored e-cigarettes, allowing popular men-
thol cartridges to stay on the market, and allowing all flavored dis-
posable e-cigarettes and open tank e-cigarettes to proliferate
through our Nation’s schoolyards, which is exactly what they are
doing.
And I am concerned that removing this authority from the FDA,
which is a part of the proposal, could lead to even more loopholes
and more industry influence.
My question is this: When formulating the budget proposal to re-
move the FDA’s tobacco oversight authority, did you, your agency
staff, White House staff, or staff of the Office of Management and
Budget, speak or meet with any lobbyists or other representatives
of the tobacco industry, or, for that matter, political operatives who
work for or are contracted by the President’s reelection campaign?
Secretary AZAR. Well, I certainly—I can’t speak for others. I am
not aware of any such deliberations. The idea was that if we move
the tobacco center out from under FDA, first, if it were a politically
appointed—a presidential-appointed, Senate-confirmed leader, they
would be more accountable to Congress. Second, as a direct report
to me, or whoever is Secretary, elevating the role of tobacco control
there.
It has always been a little bit of an odd connection. FDA is about
safe and effective, whereas the tobacco center is about regulating
a product that is undeniably bad. And so there is a——
Mr. SARBANES. It doesn’t make any sense, does it?
44
Secretary AZAR. It would be subject to Congress if it was some-
thing——
Mr. SARBANES. I mean, we are at the height of it. We are at this
tipping point on this epidemic when it comes to vaping.
I mean, there does reside, however you want to sort of carve up
what you consider the appropriate mission of the FDA to be; there
certainly exists, resides within the FDA now significant expertise
and experience in terms of dealing with this issue. Why you would
propose, at this moment in time, when this epidemic risk in a
sense overtaking the dimensions of the previous tobacco epidemic
we saw in this country, by zeroing out that authority and moving
it to an untested new agency, which, by the way, I think would be
more susceptible to political influence of the kind I was just re-
counting than it is now. It doesn’t make any sense to me. I urge
you to reconsider that. We are in the midst of this crisis, and we
have to use every tool available to us here in the government to
respond to it.
With that, I yield back.
Ms. ESHOO. The gentleman yields back.
There is 5 minutes and 22 seconds left on the clock. Any member
that would like to leave to vote, when we get to—you can leave
now. When we—when the clock goes to zero, they will hold the vote
open for those that have not arrived from our subcommittee, and
at that point, we will take a 20-minute break.
But now I would like to recognize the gentleman from Kentucky,
Mr. Guthrie, for his 4 minutes of questions.
Mr. GUTHRIE. Thank you, Mr. Secretary.
I look forward to getting into the coronavirus. I will do that in
my second rounds of questions. So the SUPPORT Act we passed
last year included my bill, the Comprehensive Opioid Recoveries
Act, to establish treatment centers that offer FDA-approved medi-
cations, and assistance treatments, all of them comprehensively.
Currently, SAMHSA has the grant application open for entities to
apply and I am glad HHS is moving fast in implementing the pro-
gram. But my question is: How is HHS implementing other parts
of the SUPPORT Act? And does HHS conduct any oversight on how
the funds are actually being used?
Secretary AZAR. So, first, thank you for the SUPPORT Act, and
it is so comprehensive we actually established a SUPPORT Act im-
plementation leadership committee to track all of the different
work streams needed under the SUPPORT Act. It is really enhanc-
ing our work across all five elements of our strategy on opioids, and
so, we are just—we are driving forward, making progress on the
opioid epidemics. We have got—the overdose deaths are down for
the first time in decades as a result of our collaborative bipartisan
efforts here, and we are implementing and using the SUPPORT
Act authority. So thank you for those.
Mr. GUTHRIE. OK. Thank you.
And also, in 2018, Congress passed my bill, the bipartisan BOLD
Infrastructure for Alzheimer’s Act. Can you please provide an up-
date on how this law is being implemented across the country?
Secretary AZAR. So, with that Act, I want to, if I could get back
to you in writing on that, I don’t have all the details on that par-
ticular program. I apologize, but if I could get back to you.
45
Mr. GUTHRIE. OK. Thank you.
And this is kind of technical from my role as ranking Republican
on the Oversight and Investigations Subcommittee on this com-
mittee. This committee and Oversight and Investigations conducted
extensive oversight, cybersecurity at HHS, including through tech-
nical audits conducted by GAO of cybersecurity controls at HHS
operational divisions. So, as I said, it is very technical.
Last Congress, the Subcommittee on Oversight and Investiga-
tions held a closed hearing, in part, because HHS failed to properly
identify and address certain vulnerabilities. We recently received
preliminary results from the most recent audit of another HHS
agency, though I can’t go into details in this setting.
So my question is: Does HHS have a point person who coordi-
nates corrective actions on cybersecurity among all HHS agencies,
and, if so, will you direct that person to continue to work with the
committee on improving enterprise cybersecurity at HHS, and en-
suring that mitigations applied in one setting are consequently ap-
plied through all of HHS?
Secretary AZAR. Yes, we do. Our chief information officer, Jose
Arrieta, who works directly with me, absolutely is in charge of
those issues. If I could go back to your previous question, I had
misheard on the BOLD Act.
Mr. GUTHRIE. On the BOLD Act, yes.
Secretary AZAR. So I apologize on that.
For fiscal year 2020, CDC will have two funding opportunities to
carat ck word. I can’t find it as a verb actions under the BOLD Act.
So first, there will be the public health programs to address Alz-
heimer’s disease and related dementias; and second, there will be
the centers of—the Health Centers of Excellence to Address Alz-
heimer’s Disease and Related Dementias. We expect both of those
funding opportunities to be out in the coming month. And for fiscal
year 2021, the President’s budget for CDC includes $3.493 million
to continue to support these Alzheimer’s activities.
Mr. GUTHRIE. Because by 2050—that is when I will be 86, I be-
lieve—they believe it is going to be a trillion, estimated to be $1
trillion spent on Alzheimer’s disease. Not only is it devastating to
the individual who has it, the family that cares for that person, but
also it would be devastating to the deficit and the budgets of our
country. So this is something very important. Thanks for your lead-
ership and effort, and I appreciate working with my colleagues
here to move the BOLD Act forward and address it.
And I yield back.
Ms. ESHOO. The gentleman yields back.
A pleasure to recognize the gentleman from New Mexico, Mr.
Luján, for his 4 minutes, and I will wait right here with you and
then we will run over.
Mr. LUJÁN. Thank you, Madam Chair.
Secretary Azar, when Donald Trump was running for office four
years ago, he famously said that he wouldn’t cut Medicaid. He
didn’t say it once or twice, but claimed it at least five separate oc-
casions, that he would not cut Medicaid but, in reality, no Presi-
dent and no administration in the last 50 years has done more to
undermine Medicaid than Donald Trump.
46
In fact, his first major legislative effort to repeal the Affordable
Care Act would have ended Medicaid as we know it, and put the
healthcare of 70 million Americans at risk. And if my colleagues
from the other side of the aisle want to protect people with pre-
existing conditions, they should drop the lawsuit. That could hap-
pen tomorrow.
After President Trump failed to cut Medicaid legislatively, he de-
cided to try the same thing administratively, even though the law
clearly does not allow it.
Secretary Azar, there has been some misreporting that the block
grant guidance is limited to adults in the expansion population, but
under the administration’s guidance, States could block grant Med-
icaid for more than just expansion adults. Isn’t that true?
Secretary AZAR. Congressman, I don’t—I don’t believe that is the
case. I will ask did CMS administrator to get back to you on that,
but my understanding was that it would be an optional demonstra-
tion for adults only, and that it would actually not affect coverage
for our most vulnerable, our pregnant women, children, elderly
adults, people on eligible on the basis of disability. But I will ask
Administrator Verma to get back to you on that, because that is
not my understanding.
Mr. LUJÁN. Let me jump into this. I am glad that you pointed
that out, because I think that there is a concern here, and I hope
that you would agree with me that, if that is your understanding,
that you do something about it, Mr. Secretary, because the Center
on Budget points out that people that are low-income parents,
women who are pregnant, and people with disabilities who are cov-
ered through Medicaid expansion could be included in what I will
describe as the President’s illegal block grant guidance.
Is that something that you would agree with if that is the case?
Would you stop it if, in fact, the guidance does allow for those vul-
nerable populations to be discriminated against?
Secretary AZAR. So I have been under the view that it does not
affect coverage for our most vulnerable populations. It doesn’t allow
them to strip benefits, or strip eligibility. Essential health benefits
have to be covered. You can’t change eligibility. You can’t cap or
limit——
Mr. LUJÁN. Mr. Secretary, if I may, just for clarification, because
it sounds like we are on the same page.
Secretary AZAR. What you are saying I am not—the concerns you
are expressing——
Mr. LUJÁN. Mr. Secretary——
Secretary AZAR [continue]. I don’t believe we are in the HOA, but
we will get back to you on that.
Mr. LUJÁN. Let me ask you this pointed question.
Secretary AZAR. Yes.
Mr. LUJÁNN. If, in fact, the President’s Medicaid block grant pro-
gram does allow for those folks to be thrown off and get caught up
in this, will you stop it?
Secretary AZAR. Well, we are not going to approve plans that
allow people to be thrown off, because it can’t change eligibility. I
can’t change eligibility.
Mr. LUJÁN. Let me ask it one more time, because it sounds like
you are getting there.
47
Mr. Secretary, if, in fact, vulnerable populations like pregnant
women, families, and those that are disabled, are subject to this
rule where they could be block granted, will you stop it?
Secretary AZAR. I don’t believe we would—I will not approve a
plan that removes coverage for our most vulnerable citizens.
Mr. LUJÁN. So that is enough for me. You said you will not ap-
prove a plan.
Secretary AZAR. I will not approve—with very low-income par-
ents, children, pregnant women, elderly adults, or people eligible
on the basis of disability should not be affected in terms of their
Medicaid coverage, is what I am informed. I will get back to you
from Administrator Verma to confirm all of those details. I want
to make sure that I am right on that, but that has been my under-
standing of the HOA program.
Mr. LUJÁN. What I am looking for is assurance that if what my
comments are associated with being consistent with the Center on
Budget points out, you, in fact, will not approve that plan and you
will not allow for Medicaid block grant cuts, devastating cuts go
into a place that will be subjected to pregnant women, families,
and those with disabilities?
Secretary AZAR. The categories that I mentioned before are ones
that I do not believe are subject to it, plans should not be approved
if they would harm eligibility for those individuals.
Mr. LUJÁN. So if the Center on Budget’s assessment is correct,
you will not allow that to go into effect?
Secretary AZAR. I do not believe their assessment or description
of the program is correct, and I have said I don’t expect that I
would approve any plan that would harm our vulnerable popu-
lations. It is a healthy adult opportunity under Medicaid expan-
sion, but we will get you any clarification on that afterwards.
Thank you for raising that to me.
Mr. LUJÁN. There is a reason that most of us in this Congress
has—have opposed Medicaid block grants. These are devastating
programs. It is another effort to undermine Medicaid, and to con-
tinue to cut the program which President Trump promised he
would not. This is another example of where he is.
And with that, I yield back.
Ms. ESHOO. The committee will now recess for approximately 20
minutes. So hold on to your seats while you stand up and stretch
and we race over and come back.
It sounded like the Secretary said yes, Ben Ray.
[Recess.]
Ms. ESHOO. The subcommittee will come to order. Thank you.
Thank you, Dr. Azar, for your patience.
And I now would like to recognize the gentleman from Virginia,
Mr. Griffith, for his—is it 4 minutes—4 minutes of questions.
Mr. GRIFFITH. Thank you, Madam Chair.
I appreciate you being here. Thank you so much. The President
and your agency have expressed concerns with the middlemen in
the drug supply chain, pharmacy benefit managers, PBMs. Over
time, PBMs have morphed into under-regulated entities with op-
portunities to exploit their position in the middle of the drug trans-
actions in the U.S. For example, according to a new report from
XIL Consulting, which is run by former Express Scripts’ executive,
48
PBMs benefit from an obscure fee known as direct and indirect re-
muneration, DIR—I know you are familiar with that—at a rate ex-
ceeding 500 percent per prescription as compared to the average
administration fee. Last year, the administration proposed a rule
to address these DIR fees, but later withdrew it.
Do you still have plans to implement accountability measures for
PBMs?
Secretary AZAR. No.
Mr. GRIFFITH. And if so, what does that regulation look like?
Secretary AZAR. So I remain very concerned about the DIR fees
and their impact, especially on America’s community pharmacists,
as well as independent specialty pharmacies.
So, the reason that we did not finalize that rule—and we were
very transparent at the time—was the concern that by—if we
forced the DIR fees to basically go through to the benefit of the pa-
tient, that that could cause an increase. The middlemen would jack
up the part D premiums for our seniors, and that was the concern
and the President just has been adamant that he does not want to
run the risk of part D premiums going up.
We—so it remains a priority for the administration to deal with
this issue. If we ever could legislatively, that would be useful also.
Mr. GRIFFITH. And as you know, I would love to have a legisla-
tive solution, but we thought this might be a good test case to do
it with that.
Secretary AZAR. Maybe even through, if we could get bipartisan,
bicameral drug pricing legislation, that might be a vehicle to have
that in there.
Mr. GRIFFITH. It might be.
And let me ask you this: There has been some mention earlier
today of H.R. 3. I raised the concern, and then later, it was raised
by the Congressional Research Service that the bill, as written, is
just blatantly unconstitutional. Have your lawyers advised you that
that is the case in their opinion as well?
Secretary AZAR. I have not had anyone study the constitu-
tionality issues on H.R. 3 about the penalty amounts and whether
that would work. So I haven’t seen any analytics on that.
Mr. GRIFFITH. Any time they want a discussion on it, I am more
than happy to facilitate one.
Let’s talk about opioids, because I only have a little bit of time
left. Over the past few years, there has been a lot talk about how
they are prescribed in America, and how pain is medically man-
aged in general. And I will tell you, that I thought we were on the
track of getting our healthcare professionals to back off of giving
out so many opioids for pain, but I have a friend who is currently
undergoing some procedures, and we were talking yesterday about
how they had given her opioids, how she took it in the initial day
after some painful procedures, but that after that, she turned it
away but they—you know, she has got it sitting in her house. What
has this administration and HHS done to reduce the overpre-
scribing of opioids?
Secretary AZAR. So we have actually, through the CDC, put out
guidance to professionals on appropriate prescribing. We continue
to work on even further titrated by different pain areas on what
the best guidance is to do that.
49
It is distressing to hear that. We have seen, though, an over-25
percent, I believe, decrease, maybe 30-percent decrease in the
opioid prescribing of illegal opioids to date since the President took
office. So we are making progress, but, of course, it is disturbing
to hear any pockets like that.
Mr. GRIFFITH. Well, and—look, it is going take time but we
can’t—just because we have started to solve the problem, we can-
not think it is solved, and we cannot take our foot off the gas pedal
in trying to make sure that we don’t overprescribe, and that we
deal with this issue. It is very serious in my district and many oth-
ers.
I thank you very much, and I yield back.
Ms. ESHOO. The gentleman yields back.
The Chair is pleased to recognize the gentleman from Oregon,
Mr. Schrader, for his 4 minutes.
Mr. SCHRADER. Thank you very much, Madam Chair.
Thanks for being here, Secretary Azar. I appreciate it very, very
much. I am going to leave my coronavirus questions to the next
panel, but we do want to make sure the CDC is fully funded, and
a little concerned about the original budget. Glad to see some
changes coming forward.
My question, the first question, is on Medicare Advantage. It is
a huge program in Oregon and many, many States. It leverages our
Federal tax dollars to maximum advantage. Most Oregonians, most
seniors get a lot of their prescription drug coverage from Medicare
Advantage. Very concerned that this administration, and frankly,
others, have tended to try and cut Medicare Advantage programs.
I think that is foolhardy. The whole goal here is to actually make
sure that the savings from the Medicare Advantage are plowed
back into making sure there are more benefits that are covered,
better prescription drug coverage, and expanding it to a larger uni-
verse.
So could you give me some assurance you are going to continue,
this administration? You will try and continue to improve the
Medicare Advantage program and not take away the savings that
could be plowed into more benefits for folks.
Secretary AZAR. No, absolutely. So I am actually under direct or-
ders of the President in his Medicare executive order to enhance
and protect Medicare Advantage, exactly the things you are talking
about: Offer more supplemental benefits, make sure people—make
those plans as attractive as options for people as possible.
Mr. SCHRADER. Just saw guidelines on reducing caps and that
sort of thing that made me nervous about what the intent was.
The second question is on the proposed Medicaid rule. Hear a lot
about that back home. In many States, I was budget chair for my
State back in the day, and it seemed like a great opportunity for
our States to, again, leverage Federal dollars with State tax dol-
lars, actually with private hospital dollars and long-term care dol-
lars. So it was a really smart use, I thought, of taxpayers’ limited
ability to finance programs they want. This really made great use
of the dollars.
I am very concerned with this new MFAR rule that you are going
to—ostensibly it is, with all due respect, framed in the guise of
transparency, when, indeed, it is a backdoor attempt to take away
50
matching funds, the ability for the provider tax to be leveraged in
many States, including ours.
So, I guess, given the fact the executive order requires Federal
agencies to perform this regulatory impact analysis to determine
the effect of the impact of the proposed rule, but the proposed rule
says the fiscal impacts of the Medicaid program from the imple-
mentation of the proposed rule is unknown. Do you consider that
to be a comprehensive regulatory impact analysis?
Secretary AZAR. I haven’t looked at the reg impact analysis
there. So I just I don’t know the specifics on that, but, certainly,
I do want to assure you we are hearing the feedback from you and
others and governors about this. We are looking at this not to be
penal, but, rather, to make sure that those intergovernmental
transfers are genuine State money that is getting matched and not
funny money or schemes—that is really the intent—and to also be
more prospective, not penal, looking backwards, as much as we
can.
So we are—I appreciate getting this feedback. We are hearing a
lot of it, and we are taking that in.
Mr. SCHRADER. Well, what some people would call funny money
schemes, others would call smart financing in using the accounting
system the way it has been established for decades to maximum
advantage. It would really put a huge hundreds-of-million-dollar
hole in the Oregon State HHS budget. So I would urge you to back
down on that a little bit, or at least give it some more serious
thought.
I yield back. I thank you, Madam Chair.
Ms. ESHOO. The gentleman yields back.
It is a pleasure to recognize the gentleman from Florida, Mr.
Bilirakis, for his 4 minutes of questions.
Mr. BILIRAKIS. Thank you. Thank you, Madam Chair. I appre-
ciate it very much.
Secretary Azar, thank you, first of all, for your leadership. I ap-
preciate it very much. And thank you for your responsiveness to a
lot of my constituents’ concerns as well.
Again, we have begun to make progress, in tackling our Nation’s
opioid crisis, and HHS has played a key role in that effort. Thank
you for your continued support, of course.
Do you feel—and this is a budget question; do you feel HHS has
the necessary resources to continue to implement provisions of the
2018 SUPPORT Act and the 2019 HHS Pain Management Task
Force recommendations?
Secretary AZAR. I do believe so. In fact, we have increased fund-
ing for opioids in this budget.
Mr. BILIRAKIS. OK. Very good.
Also, next, the community house centers, as you know, do a won-
derful job. The funding is expiring soon. Now, we reauthorized it
for an additional seven years, and that is a great thing. But, again,
how do community health centers serve as a gateway to integrated
care for individuals with mental illness and substance use dis-
order?
Secretary AZAR. You know, more than 28 million people rely on
HRSA’s community health centers that we fund. They are a critical
part of our primary care network, of preventive care for individ-
51
uals, and they deliver high-quality service. And we are using them
also as part of the Ending the HIV Epidemic program to reach the
underserved and reach people that we need to bring into treatment
and prevention.
You know, more than 93 percent of our 1,400 health centers pro-
vide mental health counseling and treatment. Sixty-seven percent
of them provide substance abuse services. I believe the—I think the
number 60 percent of the clients at the community health centers,
I believe, are ethnic and racial minorities. I am always just so im-
pressed when I visit them, the quality of care and the quality of
service there.
Mr. BILIRAKIS. Absolutely. Do you have anything to add? Because
I wanted to give you an opportunity to add, because this is a big
issue affecting our constituents, obviously, on the insulin pricing.
I know that this has been mentioned in the committee, but if you
could maybe elaborate on that, I would appreciate it very much.
Secretary AZAR. I appreciate that. I did want to clarify one thing
from Mr. Walden’s question earlier regarding a piece of legislation.
I misheard about, I guess, it is a proposal to cap out-of-pockets at
$50 for insulin. The administration does not have a formal state-
ment of administration position on that piece of legislation yet. Of
course, we want to get out-of-pockets down. We want to deal with
the insulin issue, and get insulin pricing down for everybody, but
we don’t have a formal statement yet on that issue.
The part D reforms the committee has worked on and that has
a lot of bipartisan support though, that could be such a benefit to
people, that catastrophic cap at $3,100, spreading that cap over 12
months, where no senior would ever pay more than 258 bucks a
month for their prescriptions if they opted into that. What an in-
credible thing we could deliver for America’s seniors if we could get
bicameral, bipartisan action on that.
Mr. BILIRAKIS. Absolutely.
Well, thank you for clarifying that, and, of course, we will follow
up with you, because, again, this is a big issue affecting our con-
stituents.
How does the budget address school safety? I don’t have much
time, do I? How does the budget address school safety and the
mental health needs of our students?
Secretary AZAR. So we fund Project AWARE in here, which is a
really important school-based school safety program for those for
mental health services. We have Healthy Transitions funded,
which improves access to mental disorder treatment and related
support services for youth. We have the Safe Schools Framework
Implementation Toolkit to help educate teachers and administra-
tors to identify kids in crisis who need mental health intervention.
That is part of it.
Mr. BILIRAKIS. OK. Thank you very much.
I appreciate it, Madam Chair.
Ms. ESHOO. The gentleman yields back.
It is a pleasure to recognize the gentleman from Massachusetts,
Mr. Kennedy, for his 4 minutes of questions.
Mr. KENNEDY. Thank you, Madam Chair.
Mr. Secretary, thank you for being here.
52
This week, DHS implemented their well test for immigrants na-
tionwide. The earlier estimates show that the rule could lead to 4.7
million people withdrawing—excuse me—from Medicaid and CHIP
alone, many of whom are legal immigrants, the children of immi-
grants, asylum seekers, and refugees. Yes or no, sir, nearly five
million people are forced to forego their health coverage; is that a
success?
Secretary AZAR. We do not believe that individuals who come to
this country should be dependent on public taxpayers for
healthcare or other services.
Mr. KENNEDY. So refugees having access to healthcare is a suc-
cess?
Secretary AZAR. We do not believe that individuals who should
come to this country to be dependent on public welfare programs.
That is the—that is the—that is the basis for that——
Mr. KENNEDY. So, sir, you have frequently told the story of your
grandfather arriving at Ellis Island from Lebanon as an impover-
ished teenager who spoke no English. You talk about him being
met by a member of the United States Public Health Service. You
speak proudly of that story. Under this rule, based on your own
telling of that story, your grandfather would have been turned
away. So I ask you, yes or no, are you proud of this public charge
policy?
Secretary AZAR. So my grandfather came and worked his way
through his bootstraps.
Mr. KENNEDY. Would he have gone—would he have had access
to healthcare under this policy?
Secretary AZAR. No, he would not have.
Mr. KENNEDY. And do you——
Secretary AZAR. And he wouldn’t have asked for it, because he
would have wanted to make his own way.
Mr. KENNEDY. And so you are proud of this policy.
Secretary AZAR. I am proud of my grandfather and 100 years
ago, he came to the United States——
Mr. KENNEDY. That was not the question.
Secretary AZAR [continue]. In Ellis Island.
Mr. KENNEDY. That was not the question. Are you proud——
Secretary AZAR. We supported this policy. It is—we——
Mr. KENNEDY. I am going to take that as a no.
Secretary AZAR. The American people don’t support the idea that
people should be coming to this country to be——
Mr. KENNEDY. Mr. Secretary, next question. Are you aware that
under your leadership, the number of Americans without health in-
surance has risen for the first time in a decade in 2018 by roughly
two million people?
Secretary AZAR. So actually, the numbers on the uninsured re-
quire a bit more depth than that. The—what is happening on the
uninsured is actually the ACA has—most of the growth of unin-
sured is because the ACA priced individuals out of the individual
markets.
Mr. KENNEDY. Sir, I am almost out of my 4 minutes.
Are you aware, sir, Mr. Secretary, that the percentage of unin-
sured children rose by .6 percent under your leadership? Would you
consider fewer children with access to healthcare a success?
53
Secretary AZAR. So actually, in terms of children and coverage,
we have SCHIP. We have reauthorized that for a long period of
time. We have got the Medicaid program——
Mr. KENNEDY. So you contest the numbers?
Secretary AZAR. So in terms of the uninsured numbers there, the
children that are uninsured are likely part of the coverage gap left
by the ACA, as well as the pricing out of nonsubsidized——
Mr. KENNEDY. Sir, do you believe that it is the—so last month,
we held a hearing here about an opioid epidemic where a rep-
resentative from the Department of Health and Human Services of
North Carolina stated that if North Carolina had expanded Med-
icaid, 415 more people would be alive in North Carolina today. Do
you believe that this administration’s opposition to Medicaid expan-
sion that, according to that individual, has cost lives; is that a good
policy choice?
Secretary AZAR. I am not going to validate that politician’s state-
ments. I don’t know who it was——
Mr. KENNEDY. It was a representative of the Department of
Health and Human Services of North Carolina.
Secretary AZAR. I don’t know who they are. I don’t know the
basis for that. I haven’t seen the evidence.
Mr. KENNEDY. So you are unaware of the fact that Medicaid has
saved lives in North Carolina?
Secretary AZAR. No——
Mr. KENNEDY. The absence of Medicaid expansion——
Secretary AZAR. That is not what I am saying. I am saying I
haven’t seen the evidence basis for the assertions you are making
and that he made.
Mr. KENNEDY. One last question for you. You have spoken about
this administration’s efforts to combat coronavirus and the so-
called increased choice for healthcare. For one man, Osmel Mar-
tinez Azcue, those two things recently converged when he tried to
be prepared after developing flu-like symptoms following a trip to
China. He was left with a bill of well over $1,000, and a demand
of proof that the flu he was tested for wasn’t related to any pre-
existing condition, or else he would be forced to pay a few thousand
dollars more.
So, please explain to me as we are staring down a potential pan-
demic, and the CDC is warning about fundamental changes to our
way of life because of it, do millions of people that have signed up
for junk insurance plans pushed by this administration, do they
really have a choice?
Secretary AZAR. So the short-term limited duration plans are an
option for individuals. We have been very clear that they may be
the right choice for some, but they may not be the right choice for
others who have preexisting conditions.
Mr. KENNEDY. Even people with thousands of dollars of unin-
sured claims in the midst of a potential pandemic, that is a good
choice?
Secretary AZAR. So if an individual, if it is a choice between no
insurance and some insurance at 60 percent lower than what the
Affordable Care Act has priced them out of the market at, it is at
least an option for individuals provided.
Mr. KENNEDY. Unless they expanded Medicaid.
54
I yield back.
Ms. ESHOO. The gentleman yields back.
It is a pleasure to recognize the gentleman from Indiana, Dr.
Bucshon, for his 4 minutes of questioning.
Mr. BUCSHON. Thank you very much.
And thank you, Mr. Secretary, for being here today.
I am going to switch gears a little bit. 340B is a critical program,
especially for rural hospitals, and I am just interested in what you
think should be done, if anything, to continue to ensure that the
340B program, given its significant growth, is helping more pa-
tients get access to care?
Secretary AZAR. You put your finger right on it there when you
mentioned the growth. It has grown from $7 billion of pharma-
ceutical sales in 2012 to $19.3 billion in 2017, and we believe in
the 340B program, but we do believe those savings need to actually
make their way to patients, not just subsidizing hospitals, but actu-
ally make their way to patients.
I mean, imagine, for instance, just take the issue of insulin. Hos-
pitals often acquire their insulin at an extremely low price, but
they don’t have to necessarily pass those savings on to the patient
that they are serving as an outpatient. That is partly why we
would, part B, propose the changes and have tried to implement
the changes that would reduce what seniors have to pay for part
B—for—would have to pay in the Medicare program for their
drugs.
Mr. BUCSHON. Do you think that more transparency in the 340B
program would be part of the solution?
Secretary AZAR. Absolutely. We support transparency in the pro-
gram. We support giving the regulatory authority as part of our
budget, and also requiring that hospitals that want to get the ben-
efit of those savings I just talked about, to retain that in the pro-
gram, would have to dedicate one percent of their work towards de-
livering charity care which seems like a pretty low bar.
Mr. BUCSHON. So what you are saying is probably that HRSA
does need probably more authority and more teeth to address the
program. Would you agree with that?
Secretary AZAR. We need greater oversight, but we need regu-
latory authority to implement that oversight so that we can have—
so we can actually do audits in an enforceable way and have that
type of transparency.
Mr. BUCSHON. Thank you.
I would also like to thank you for making improvements in pain
management a key component of the HHS opioid strategy plan. I
mean, I firmly believe we will never successfully address the opioid
epidemic unless we also improve pain management, and I am a
physician, and patient access to non-opioid therapies, particularly
FDA-approved medical devices, which have the greatest opioid-
sparing potential.
Can you tell us what HHS is doing to promote pain management
best practices and the status of various provisions in the SUPPORT
Act to break down barriers to non-opioid therapies for pain?
Secretary AZAR. So one of my top priorities has been to leverage
the Center for Medicare and Medicaid Innovations authorities to
fight the opioid epidemic and that is why we developed the Mater-
55
nal Opioid Misuse, or the MOM Model, and we recently announced
the participants in that model and that is going to address the
fragmentation of care for pregnant and postpartum Medicaid bene-
ficiaries with opioid use disorder by supporting care coordination
and better integration. So that is part of that.
Mr. BUCSHON. Great. And earlier in the hearing, you were start-
ing to give some bullet points on, I think, corona, your plan, the
five-point plan or whatever. In the last 50 seconds, can you expand
on that?
Secretary AZAR. You bet. First, expand our surveillance system
so we have novel coronavirus surveillance comparable to what we
have on the flu, because that is the bedrock of our public health
response; second, money to support State and local public health
departments are going to have to do a lot of work here; third, vac-
cine research and development; fourth, therapeutic research and
development; and fifth, finally, strategic national stockpile acquisi-
tion, especially of personal protective equipment.
Mr. BUCSHON. Thank you for that.
And do you feel that we have had enough access to—in China to
get the data that we need to help solve this problem? Has that
loosened up?
Secretary AZAR. We have struggled. The World Health Organiza-
tion GOARN team has now completed its mission. We are waiting
for its report. The initial reports I have is that that team felt they
were getting access to information and evidence, but I want to see
the final results of that.
Mr. BUCSHON. Thank you, Mr. Secretary. I yield back.
Ms. ESHOO. The gentleman yields back.
Just for the record, HHS has existing oversight authority of the
340B, and it is my understanding that HRSA has conducted 1,500
audits of the program. So the question——
Secretary AZAR. The courts actually have said we do not have the
ability to implement regulations. So that—and that——
Ms. ESHOO. We are not talking about that. We are talking about
audits, and so that is why I wanted to get this on the record. Look
at your audits and see what is in them. It is under the control of
your department.
I now would like to call on, or recognize, the gentleman from
California, Mr. Cárdenas, for his 4 minutes.
Mr. CÁRDENAS. Thank you very much, Madam Chair, and I ap-
preciate the opportunity for us to have this oversight hearing.
Secretary Azar, thank you so much for being with us. This is an
opportunity for to us ask you some essential questions in fulfilling
our oversight duties. And last time you were here before us for our
budget hearing, I asked you about your agency’s role in the horri-
fying practices of separating children from their families. Today, I
would like to ask you about other ways that the administration is
impacting families, both in my district and throughout the country.
I would like to ask you about an issue that is frightening families
in my own district. I am, of course, talking about the for-profit com-
pany’s proposal for a detention center in my district, a proposal ap-
proved by HHS and that wants to use our Federal tax dollars to
put a facility there to have children in a prison-like setting.
56
VisionQuest, the company that received these funds from your
agency, has a history of alarming reports and stories of abuse with-
in their programs right here in this country. These stories include
descriptions of excessive use of physical restraints and isolation,
verbal abuse, food deprivation, humiliation and intimidation, and
even deaths and this is all about them having children in their
care.
As part of the due diligence of your organization, would officials
within the Office of Refugee Resettlement be aware of these types
of violations before awarding a contract to such a company like
VisionQuest?
Secretary AZAR. I don’t want to endorse the statements that you
have made regarding that entity, because I do not know the par-
ticulars of that entity or the allegations that are being made there.
So I want to be careful I am not endorsing that, but——
Mr. CÁRDENAS. OK. Go ahead.
Secretary AZAR [continue]. I would expect it would be part of any
grant review of any grantee to examine their past history, and
treatment of children. I would absolutely expect that, yes.
Mr. CÁRDENAS. OK. If you could please report to this committee
if any of the grantees, such as the one I was talking to, if there
is any evidence within the Department of any valid situations with
an organization such as—an organization that would be entrusted
with Federal funds to house children.
Secretary AZAR. Sure.
Mr. CÁRDENAS. OK? Thank you.
But funds—these funds that you would be providing as of, unless
you were to have such evidence; you would go ahead and contract
with an organization?
Secretary AZAR. Well, that is how, as you know, the Unaccom-
panied Alien Children program runs, is we hire grantees that run
permanent, hopefully, permanent State-licensed facilities that care
for children until we can place them with sponsors. That is really
what the system Congress set up. That is what we run.
Mr. CÁRDENAS. Thank you.
And the city of Los Angeles is in the process of solidifying their
ordinances to whether or not they are going to allow private enti-
ties to use Federal funds to house children.
I have another issue I would like to discuss with you. I want to
turn to the issue of impacting American families, especially vulner-
able children throughout America. In your written testimony, you
speak about the importance of promoting adoption to give children
the stability and love during their childhood. You speak about
prioritizing adoption, but you neglect to mention the fact that right
now in America, the agencies are turning away qualified potential
parents because they are either LGBTQ, or they happen to be of
a religious minority here in America. This is in the—this is in spite
of the fact that LGBTQ parents are seven times more likely to fos-
ter or adopt children than non-LGBTQ parents.
My question is, in your efforts to identify and address barriers
to adoption, can you tell me how eliminating data collection and re-
porting on sexual orientation over fostering adoptive youth and
parents is helpful to furthering that goal?
57
Secretary AZAR. So the AFCAR is what you are referring to, I be-
lieve, is the AFCAR’s reporting system and the original regulation
contain 270 individual data points, 153 of which were new, and the
States, there was significant feedback about just the sheer volume
of data collection and expense to States, all of which is money that,
if we add more and more questions, more and more data collection,
that is money the States can’t use to actually assist with adoption
and foster care placement. So it is really just an effort to stream-
line those data requests in there.
Mr. CÁRDENAS. My time has expired.
I yield back.
Ms. ESHOO. Is the gentleman yielding back?
Mr. CÁRDENAS. Yes.
Ms. ESHOO. I thank the gentleman.
It is a pleasure to recognize the gentlewoman—and that she is—
from Indiana, Mrs. Brooks, for 4 minutes.
Mrs. BROOKS. Thank you, Madam Chairwoman.
And welcome, Secretary Azar. Thank you for being here.
And thank you for pointing out that just this past June, the
President signed PAHPA, the reauthorization of PAHPA, of which
this committee worked very hard on in the last Congress, and we
finally got it done in this Congress.
And I worked particularly hard with the chairwoman and the
ranking member of this committee to try to make sure we im-
proved our readiness and our response, and because the question
of a pandemic is really not a question of if, but when, I think most
people, and obviously CDC is acknowledging that.
One thing I would like people who are listening to understand,
the global security—Global Health Security Index was recently
issued, and the United States of America was first in the world out
of 195 countries for prevention, detection, response, and public
health. And I also want to commend the administration for the Na-
tional Health Security Strategy that was put in place for 2019 to
2022. I want to commend you for leading that work.
But with respect to PAHPA, I am curious. How are you
leveraging, how is HHS leveraging all of the new things that we
put into PAHPA? And then I have one—I would like to also ask
you to address, because there are so many good things in your
budget, but I am particularly concerned about a $200 million cut
to BARDA, because BARDA has brought forth so many incredible
innovations and the partnership that they have with the private
sector. Given this proposed cut, what strategies are we going to put
in place if BARDA is cut?
Secretary AZAR. So on the BARDA question, so that was, of
course, in the budget before the coronavirus situation, and because
Congress in the appropriations in December added, I think, $535
billion of Ebola funding available in 2020, we are pulling forward
some of our acquisition strategies for BARDA into 2020 around, es-
pecially vaccine and therapeutics on Ebola.
So that created some offset. We may need to relook at that now,
given some of the offsets proposed in the supplemental requests but
that was meant to be somewhat because we had pulled forward
some of those acquisition strategies to 2020.
58
Mrs. BROOKS. OK. But the private sector companies who are our
partners in developing the diagnostics, the therapeutics, the vac-
cines, and because the government is the customer for those prod-
ucts, is it fair to say then that BARDA, and all of the BARDA pro-
fessionals who are working in BARDA, is it fair to say that they
should not anticipate, with what is happening right now a cut in
their funding?
Secretary AZAR. We would—first, we would work with the appro-
priators as to whether the offset we proposed on the 535 Ebola to
be part of the funding of the supplemental, if that happens. I can
tell you from feedback this morning at the House Appropriations
Committee, I think that may be unlikely from the appropriators.
Mrs. BROOKS. We still have Ebola in Africa. Is that correct?
Secretary AZAR. We do, although fortunately, it is on the down-
swing on the Epi Curve at this point but what we would do is use
that money for acquisitions on Ebola, if that money remains there
for Ebola in 2020 vaccines and therapeutics that we have got. But
if not, we would work with appropriators on making sure BARDA
is adequately funded certainly.
Mrs. BROOKS. And are there any other issues or any other strate-
gies or framework that we provided in PAHPA that you are using
specifically right now to combat the coronavirus?
Secretary AZAR. On the coronavirus, the—I can’t trace directly to
the PAHPA authorities but, for instance, our vaccine strategies are
very much influenced by that in terms of recombinant DNA, the
universal vaccine research that we are doing in the influenza case,
as well as cell-based technology to bring domestic manufacturing
capabilities here.
Mrs. BROOKS. I yield back my time. I thank you.
Ms. ESHOO. The gentlewoman yields back.
Just for the record, the gentlewoman asked about the $200 mil-
lion cut to BARDA, and the Secretary responded.
The administration, Mr. Secretary, put out the budget ten days
after, after, not before, after declaring a public health emergency.
So your answer is really not correct on that.
Secretary AZAR. Well, I am sure you understand the budget is
locked in December. So it is already probably was printed by the
date of the coronavirus outbreak.
Ms. ESHOO. Well, you mean the administration doesn’t have the
ability to call it in and cross something out and say, N-O, we are
the not cutting this, we need it? I mean, that is not—come on.
Come on. All right.
Now the gentleman from Vermont, Mr. Welch, is recognized for
4 minutes.
Mr. WELCH. Thank you.
Thank you, Mr. Secretary. You have been here a while.
Drug importation, we are very happy that you are proceeding on
that and, as you know, we have a Republican Governor in Vermont
who is extremely interested in getting authority to do this. They
hope to have everything that is required for you sooner than the
deadline. So we think it is a great opportunity. Our Republican
Governor and Democratic legislature wants to take advantage of
this.
59
One of the concerns that the Governor has, in particular, but all
of us, is including insulin and that is not included, and my under-
standing is that there have been some concerns raised as to wheth-
er that can be safely done. It really would make a huge difference
to Vermonters and, as you know, a lot of people already drive
across the border to get insulin, and even some companies do that.
Our view is that the concerns about safety are always legitimate,
no matter where the source of drugs, but our real request is to ac-
commodate insulin as one of the drugs that could be imported as
long as it is done safely. I wish you could comment on that and tell
us what we need to do to give some relief to folks that are des-
perate about the cost difference.
Secretary AZAR. So unfortunately, insulins as an injectable prod-
uct are expressly excluded under Section 804 of the Food, Drug,
and Cosmetic Act which is the provision for the Canadian importa-
tion regime that we are using. We have no objection to it. In fact,
the second part of the importation program where a drug company
could bring a product in with a new drug code and actually price
it at their—price at a lower list price so that they could deal with
their PBM, those middlemen contracts, that are open for all prod-
ucts, including insulin.
Mr. WELCH. So let me just understand. This is helpful. You are
saying it is because the statute——
Secretary AZAR. Yes, we have—we did not——
Mr. WELCH [continue]. Not because of a concern that HHS has.
Secretary AZAR. It is the statute.
Mr. WELCH. So as far as you are concerned, if you felt there was
authority under the law for insulin to be included, you would see
no reason to object to that.
Secretary AZAR. That is correct. We would be supportive if the
statute provided for that. We believe it can be imported appro-
priately, but the statute does not allow me to approve an importa-
tion regime under 804 with insulins in it.
Mr. WELCH. So if we did an amendment to the statute to allow
for insulin to be an exception, you would be supportive of that, it
sounds like.
Secretary AZAR. I can’t formally state an administration position,
but I can tell you the President wants importation. He wants it
yesterday, and we are delighted the Governor is working, because
we want shovel-ready importation programs that, when we finalize
a rule that we could get to work on approving.
Mr. WELCH. All right. So who would I follow up within the ad-
ministration? It probably sounds like you——
Secretary AZAR. Me.
Mr. WELCH [continue]. But if I talk to the President about sup-
porting what statutory provision may need to be included in order
to allow insulin to come in. That would be huge, huge, huge for the
Governor of Vermont, and for the people of Vermont.
Secretary AZAR. Sure. Happy to work with you on that. Abso-
lutely. Talk directly to the President with you.
Mr. WELCH. All right. Thank you.
And I yield back.
Thank you very much——
Secretary AZAR. You bet.
60
Mr. WELCH. [continue]. Mr. Secretary.
Ms. ESHOO. The gentleman yields back.
The gentleman from Georgia, Mr. Carter, is recognized for 4 min-
utes.
Mr. CARTER. Thank you, Mr. Secretary, for being here.
I want to follow up on Representative Griffith’s questions about
DIR fees by the pharmacy benefit managers and, of course, as you
know, the PBMs have squeezed out almost $4 billion out of phar-
macies that have retail pharmacies with these DIR fees. In a sur-
vey that was done by the National Community Pharmacists Asso-
ciation said that 58 percent of the independent retail pharmacists
in this country don’t expect to be in business in two years, the re-
sult of DIR fees which, of course, should be of concern to all of us,
but particularly to HHS and delivery of healthcare services in our
country.
I just wanted to ask you. I believe you responded to Mr. Griffith
by saying that the concern was the higher premiums with the in-
surance companies. As you know, three PBMs account for almost
80 percent of the market share in this country, and all of those
PBMs are owned by insurance companies. How can we—how can
we answer the question of whether those rebates that they are get-
ting, the PBMs they are giving, are going back to the insurance
company that is also owned by the same company?
Secretary AZAR. Well, that is one of the real problems we have
got, is we don’t have PBM transparency. Absolutely. So we can’t ac-
tually know where those monies are flowing.
Mr. CARTER. It would appear to me that that is just taking
money out of one pocket and putting it in the other pocket. I mean,
it is the same company and then it is extended even more than
that to include the pharmacies as well. So you know, the vertical
integration is something that has got to be addressed.
But what do you think we can do to address the DIR fees? Now
the DIR fees have been associated with higher out-of-pocket costs
for recipients, and that is certainly something we have to be con-
cerned about, and I know you are concerned about and you have
said in the past that you are. If we can lower out-of-pocket costs,
would it help to have the rebates at the point of sale?
Secretary AZAR. Oh, yes, it would help to have rebates at the
point of sale. That would lower out-of-pocket costs. And pushing
through, so folks understand, the DIR is basically a penalty provi-
sion that the middlemen impose on the community pharmacists,
but the patient is made to pay off of the full price when they buy
the drug and the pharmacy later may get this callback of this pen-
alty, but the patient doesn’t get a refund of their out-of-pocket.
Mr. CARTER. Absolutely. And that callback can take place almost
a year afterward——
Secretary AZAR. Exactly.
Mr. CARTER [continue]. And sometimes two years afterward.
Secretary AZAR. Very unpredictable to the community pharmacy.
They are struggling from this. Absolutely.
Mr. CARTER. Absolutely.
Now I want to switch to the coronavirus and these are yes-or-no
questions, if you could answer them for me. At this time, at this
time, are you and others involved in preparing for a potential
61
COVID-19 outbreak, doing everything you can to prepare for such
an event?
Secretary AZAR. We are indeed.
Mr. CARTER. At this time, if you and others involved in preparing
for a potential COVID-19 outbreak felt like you needed more
money, would you have asked for it?
Secretary AZAR. I would have and I have and that request is
there.
Mr. CARTER. OK. At any time, if you and others involved in pre-
paring for a potential COVID-19 outbreak need more money, will
you ask for it?
Secretary AZAR. I will indeed.
Mr. CARTER. Absolutely. So it is not as to say that the amount
of money that is asked for is proportional to the effort that is going
to be put forth to prepare for this?
Secretary AZAR. Right. That is right. And the President has
made very clear in my own discussions with him, as well as pub-
licly, that we want to work with Congress on an appropriate sup-
plemental proceedings here and we have said—it quite deliberately
says at least $2.5 billion. We want to work with Congress. We got
to get that money and make sure that Congress is satisfied with
the funding also.
Mr. CARTER. As should be the case.
And, again, if you find out that you need more, you are going to
come back to us, and we are going to approve it. We want you to
have everything that is available that you need to prepare for this.
And you are going to do that, correct?
Secretary AZAR. That is correct.
Mr. CARTER. Madam Chair, I yield back.
Thank you, Mr. Secretary.
Ms. ESHOO. The gentleman yields back.
The Chair recognizes the gentleman from California, Mr. Ruiz,
for 4 minutes.
Mr. RUIZ. Thank you, Secretary Azar, for being here today.
As a father and a physician, I care very deeply about the phys-
ical and mental health of children and also children while in the
custody of the Office of Refugee Resettlement. And I am glad my
colleague Tony Cárdenas brought that up because I am also deal-
ing with a similar situation in my district.
ORR’s website says their unaccompanied children program,
quote, ‘‘takes into consideration the unique nature of each child’s
situation and incorporates child welfare principles when making
placement, clinical, case management, and release decisions that
are in the best interest of the child.’’
So let me get this straight, because I definitely want answers.
When determining appropriate housing for children in ORR cus-
tody, do you give grants to for-profit organizations with a docu-
mented history of child abuse?
Secretary AZAR. Again, I can’t speak to that particular grant that
was raised before. We would give grants to for-profit or nonprofit
without discrimination, but——
Mr. RUIZ. OK. So the caveat is those with a documented history
of child abuse.
62
I recently learned that, in addition to the facility in Arleta, Cali-
fornia, ORR is providing a grant to VisionQuest to open a 130-bed
shelter for unaccompanied children in the city of Hemet, California,
which I represent. VisionQuest is a for-profit organization whose
history suggests that their focus is to make money rather than care
about the well-being of children.
This is exemplified by VisionQuest’s very long history of keeping
children in abusive and harmful conditions, which my colleague
touched on. Dating all the way back to 1987, a report from the
RAND Corporation found that, quote, ‘‘the treatment methods used
by VisionQuest were unorthodox’’ and that ‘‘activities engaged in by
the youths posed unnecessary risks to their health and safety.’’
Last year, the Associated Press reported that in 1994 the Depart-
ment of Justice documented episodes of physical and mental abuse
at a VisionQuest shelter in Franklin, Pennsylvania, including staff-
ers pulling children’s hair, using harsh restraints, choking minors,
and even slamming them into walls.
And in 2017 the city of Philadelphia had to end a contract with
VisionQuest after State inspectors found that staff members had
choked, slapped, and injured children in the facility.
Secretary, as our providing Federal funding to a for-profit organi-
zation with a long history of child abuse is definitely not in the best
interest of children, are you familiar with these reports?
Secretary AZAR. I am not familiar with all of those reports. Some
of the allegations that you raised, I am familiar with.
Mr. RUIZ. Here is the report.
Secretary AZAR. Of course, whether for-profit or nonprofit is not
the factor——
Mr. RUIZ. This is the RAND report.
Secretary AZAR [continue]. But we want to ensure that any
grantee——
Mr. RUIZ. And this is a——
Secretary AZAR. Thank you.
Mr. RUIZ [continue]. Letter within the Department of Justice doc-
umenting
Secretary AZAR. Thank you. I appreciate that.
Mr. RUIZ. My question now——
Ms. ESHOO. Would the gentleman be seated and speak from the
microphone so that what you say can be properly recorded?
Mr. RUIZ. Sure. Will do.
So, now——
Secretary AZAR. Of course, one of these is, I just noted, from
1994.
Mr. RUIZ. Of course. So that is why I mention a long history of
abuse.
Secretary AZAR. But we will make sure any grantee is appro-
priate to the——but we need to make sure that——
Mr. RUIZ. And so that is why——
Secretary AZAR. Correct, and not——
Mr. RUIZ. That is why, when you look and review at these pro-
grams, I want to ask you, what is the process? Is there trans-
parency? How do you determine and how do you open this up to
communities to determine who is going to house children with the
safety of these children in mind?
63
Secretary AZAR. So, for these permanent bedded facilities, which
is our goal at the request of Congress, the grantees would actually
have to be State-licensed. And so there is a State licensure proce-
dure.
Mr. RUIZ. OK.
Secretary AZAR. That would be the community involvement.
Mr. RUIZ. Well, the State of Pennsylvania denied them their abil-
ity to take care of children because of those horrible——
Secretary AZAR. And then they would not be able to be a grantee
in that case.
Mr. RUIZ. And they had to close that facility.
So the question is, when you look at those reports and you re-
view the evidence, would you be open to reevaluating these grants
and your relationship with VisionQuest——
Secretary AZAR. I will ensure——
Mr. RUIZ [continue]. And their care for ORR?
Secretary AZAR. I will ensure that ORR has looked at these and
this was part of the evaluation criteria in looking at them.
Of course, just because an entity has—all of the behaviors you
described are absolutely unacceptable. I just want to be very clear
about that.
Mr. RUIZ. And I am glad you said it, because I——
Secretary AZAR. Absolutely unacceptable——
Ms. ESHOO. The gentleman’s time has expired.
Secretary AZAR. Thank you.
Ms. ESHOO. The Chair recognizes the gentleman from Missouri,
Mr. Long, for his 4 minutes.
We really need to move along, because we have another panel,
and everyone knows it is a very important one. So let’s stay within
our time.
Mr. Long, 4 minutes.
Mr. LONG. Thank you, Madam Chairwoman.
And, Secretary Azar, I want to thank you for being here today.
I know we tried to get together one time, and as soon as we sat
down, my phone started blowing up that my house was on fire in
Missouri, which it turns out it wasn’t, but the alarm company peo-
ple seemed to think it was and they sent the fire department. I am
sure you remember that.
But I want to thank you for working so hard to advance the ad-
ministration’s health agenda on behalf of the American people.
As you note in your testimony, rural Americans face many
unique health challenges. And, under your leadership, HHS cre-
ated the Rural Health Task Force and is proposing a four-point
strategy to transform rural health, which is vitally important in my
area, as I represent a lot of rural areas.
Can you first speak to the Rural Health Task Force’s role in
identifying the needs of rural areas and how to meet those needs
department-wide?
Secretary AZAR. You bet. Yes, absolutely. Thank you.
The Rural Task Force identified four key priorities for us. The
first, we have to develop a sustainable model for rural healthcare.
We can’t just patch it over with money if it is not underlying eco-
nomically viable. Second, we have to have prevention and health
promotion in rural America. Third, we have to leverage technology
64
and innovation like telehealth. And, fourth, we have to get the next
generation of providers out into rural America, and we have to
allow nurse practitioners and P.A.s to practice to the full extent of
their license in rural communities.
Mr. LONG. OK. Thank you.
And one area in rural health that has been seriously impacted
over the last few years is durable medical equipment, as you are
apprised of. I was pleased that CMS issued the interim final rule
in May of 2018 that provided payment relief for durable medical
equipment in rural areas and continued the relief in the 2019 end-
stage renal disease final rule until the end of 2020.
Can you tell me if CMS plans to continue this relief in rural
areas after 2020?
Secretary AZAR. So I am not able, obviously, to discuss a pending
regulatory action, but I do know that that was a major priority, to
get that payment fix in place through the interim final rule to en-
sure better equity for rural America. So that remains very much
top of mind for us.
Mr. LONG. OK.
And in the President’s fiscal year 2021 budget, there is a provi-
sion that would expand the competitive bidding program for dura-
ble medical equipment into rural areas in 2024. We have heard
many complaints about the competitive bidding program over the
years, really since its inception. Can you detail how you would like
to reform the program and how it would impact rural areas?
Secretary AZAR. Yes. What we would like to do in the budget is,
actually pay for durable medical equipment under the competitive
bidding program and move that, though, from a single payment
amount that is based on the maximum winning bid to actually pay-
ing suppliers on their own bid amounts and then expanding the
competitive bidding to additional geographic areas, including rural
areas.
We think that would actually enhance access to DME in rural
areas by allowing competition there rather than simply having to
depend on the payment result secured elsewhere. We think that
can solve a lot of the access challenges that we saw that we had
to work to fix with the interim final regulation.
Mr. LONG. OK.
And has CMS engaged with outside experts, economists, or con-
sumer groups on this as it considers expanding the competitive bid-
ding program?
Secretary AZAR. We do. We engage with stakeholders and experts
before we consider any new policy. And, of course, the benefit when
we do notice-and-comment rulemaking is to get that feedback.
Mr. LONG. Would you go forward with the proposal without the
Congressional approval?
Secretary AZAR. I believe, for some of the regional elements on
competitive business, I believe that we—I don’t know if we require
statutory authority. I want to get back to you on that, as to wheth-
er the budget has that as an administrative action or a statutory
request. If I could get back to you, Congressman, on that.
Mr. LONG. If you would, I would appreciate it.
Secretary AZAR. You bet. Thank you.
Mr. LONG. And I yield back.
65
Ms. ESHOO. The gentleman yields back.
The Chair now recognizes the gentlewoman from Michigan, Mrs.
Dingell, for her 4 minutes of questions.
Mrs. DINGELL. Thank you, Madam Chair.
Thank you, Mr. Secretary. I know it has been a long afternoon.
It has been nearly a month since you declared a formal public
health emergency and response to the coronavirus global threat.
On February 2, you sent a letter to Congress that you intend to use
or transfer or reprogram authority to reallocate approximately
$136 million from current programs.
Yesterday, we got the details of those transfers, and I would like
to request unanimous consent to enter that into the record.
Ms. ESHOO. So ordered.
[The information appears at the conclusion of the hearing.]
Mrs. DINGELL. Thank you, Madam Chair.
These include $62 million transferred out of NIH, $37 million
taken from the Low Income Energy Assistance Program, and $7.5
million from the Centers for Medicare and Medicaid.
Given that you plan to take $37 million from the Low Income
Energy Program, do we have any estimates of how many people
that is going to impact and who is going to go without heat this
winter?
Secretary AZAR. So, for the transferred reallocation authority,
that works out to a 0.2-percent change. And we did that across the
Department evenly, but then, within different agencies, they se-
lected various programs.
On LIHEAP, we are now late in the season, almost at the end
of February. I don’t have an analysis for you of——
Mrs. DINGELL. Can we get, for the record, please, what we think
the impact will be? Because we obviously are worried about people
who aren’t going to have heat.
You are going to take—and I don’t mean to be—I just have to
go fast. I have 4 minutes. You are going to be taking—you took $62
million from NIH. Is that going to harm our ability to conduct med-
ical research into new cancer treatments—I am happy, with you,
that opioid deaths have gone down this year. There is no one who
feels stronger. Maybe Annie. We are together—and meet other pub-
lic health challenges. What is going to happen to those programs?
Secretary AZAR. So the NIH, in doing the reallocation and taking
their allotment of the 0.2 percent, they firewalled off certain prior-
ities, including, I know, opioid research and development is one of
the primary areas——
Mrs. DINGELL. So it has not been cut?
Secretary AZAR [continue]. Pediatric cancer—right.
Mrs. DINGELL. All right.
Now, I know you talked about this yesterday, but you stated in
your Senate testimony yesterday that the U.S. Currently has about
30 million stockpiled N95 respirators, which are masks that can
help stop a person from inhaling infective particles, but that it
might require 300 million for healthcare workers alone. This
doesn’t include masks, gloves, and personal protective equipment.
That was yesterday. We have heard about nearly 900 more cases
worldwide, 60 more deaths. I am really worried, as I know the
Chair is, about the supply chain in this country. Your own agency
66
has stated that 65 percent of N95 respirators are manufactured
outside of the U.S., in China and Mexico. Yesterday, The Wash-
ington Post told us that a large group-purchasing organization says
we may only have a 2-week supply.
I don’t want to frighten anybody. We shouldn’t be rushing off.
But are we facing an imminent shortage of N95 respirators and
other personal protective equipment?
Secretary AZAR. So I did want to clarify on the numbers that I
told the appropriators this morning. After the hearing, I learned
some additional information about the number of masks that we
have. We have a higher number, but the mix is different. So we
have 30 million surgical masks, the gauze masks. We have 12 mil-
lion N95 NIOSH-certified masks, and then five that are not
NIOSH-certified—5 million N95s. So I just wanted to clarify the
data on that.
One of the things we are doing with the transfer money that we
discussed earlier is contracting to get—get contracts started with
domestic manufacturers of N95 masks so that we can scale up pro-
duction——
Mrs. DINGELL. But how long is it going to take to scale up that
production?
Secretary AZAR. It will take time because we do not have as
much domestic manufacturing——
Mrs. DINGELL. Is it a national security threat that 90 percent of
our generics are coming from China? We have this kind of short-
age. What are we going to do—and I am out of time—to help bring
the kind of production of these kinds of essentials to this country
so we are not dependent on anyone else?
Ms. ESHOO. The gentlewoman’s time has expired.
The Chair recognizes the gentlewoman from Delaware, Ms. Blunt
Rochester, for 4 minutes.
Ms. BLUNT ROCHESTER. Thank you, Madam Chairwoman.
And, also, welcome, Mr. Secretary.
I have to express my deep concern and disappointment in the im-
plementation of the Affordable Care Act, which is the law of the
land. It appears that the Department of Health and Human Serv-
ices has made it harder for Americans to access and afford the vital
health insurance coverage that they rely on.
Your department recently proposed a rule that would discontinue
the ACA subsidies for low-income families who do not actively re-
apply during the ACA’s open enrollment period. These are low-in-
come Americans who are currently enrolled in zero-dollar-premium
plans.
Secretary Azar, your department’s analysis acknowledges that
there are 270,000 Americans who are reenrolled in these zero-dol-
lar-premium plans that could lose their coverage. And yet you pro-
posed ending auto-enrollment for these individuals, thereby endan-
gering their coverage.
First, a ‘‘yes’’ or a ‘‘no’’ question: In deciding to propose this pol-
icy, did you consider the fact that it would result in American fami-
lies losing coverage?
Secretary AZAR. I want to get back to you for the record, if I
could. I don’t know that we actually proposed it, as opposed to ask-
ing for comment on whether one should allow auto-reenrollment for
67
people that are 100-percent subsidized in the ACA exchange mar-
kets. I think we asked just for comment on that, as opposed to pro-
posing that as the approach.
Ms. BLUNT ROCHESTER. So I am assuming, if you are asking for
comment, it is something that you are considering?
Secretary AZAR. It is under consideration, if we should require
someone to apply who is getting 100 percent of their subsidy paid
for, their premiums paid for, should they affirmatively demonstrate
that they continue to qualify on an income and wealth basis for
that, as opposed to just rolling over and then pay and chase later
if we find months later, they don’t qualify.
Ms. BLUNT ROCHESTER. So can you guarantee that no individuals
would lose coverage as a result of this policy?
Secretary AZAR. Well, if they don’t qualify, then they wouldn’t re-
tain coverage at 100-percent subsidy——
Ms. BLUNT ROCHESTER. Meaning, if you changed the policy, then
they wouldn’t qualify and they could lose——
Secretary AZAR. They shouldn’t qualify.
Ms. BLUNT ROCHESTER. I am particularly alarmed that your de-
partment would propose such a policy given that Congress statu-
torily directed you to establish automatic reenrollment for all indi-
viduals enrolled in the marketplace. That provision was signed into
law by the President at the end of the year. This proposed policy
goes against congressional intent.
Mr. Secretary, will you commit to the American people that you
will not take any action that would cause American families to lose
their health insurance? That is just a ‘‘yes’’ or ‘‘no.’’
Secretary AZAR. I believe that rider was with respect to 2020
moneys, and the request for information was regarding the 2021
plan year, which is not subject to that rider, is my understanding.
Ms. BLUNT ROCHESTER. The deep concern is that the Department
now has a record of refusing to properly invest in robust adver-
tising and outreach. The Department has drastically reduced fund-
ing for outreach and education activities. It has gutted the Navi-
gator program, limited the time for enrollment, and is giving con-
sumers less opportunity to make informed choices. Now the De-
partment threatens to discontinue American families’ subsidies
who have become accustomed to being reenrolled every year.
Mr. Secretary, would you commit to working with me to ensure
that Americans wishing to enroll in coverage will be well-informed
about the opportunities to enroll?
Secretary AZAR. Well, I am always happy to work with you, Con-
gresswoman, on any issue.
Ms. BLUNT ROCHESTER. Well, we have talked about working to-
gether before, so I just want to put it on the record on this par-
ticular issue.
Secretary AZAR. So, you know, just in terms of open enrollment,
we put out a billion reminder emails, we had——
Ms. BLUNT ROCHESTER. It is just a ‘‘yes’’ or ‘‘no’’ question, be-
cause my time has expired. Yes?
Secretary AZAR. Happy to work with you.
Ms. BLUNT ROCHESTER. OK. We will follow up.
Thank you, Madam Chair.
Ms. ESHOO. The gentlewoman’s time has expired.
68
The Chair recognizes the gentlewoman from California, Ms.
Barragán, for her 4 minutes of questions.
Ms. BARRAGÁN. Thank you.
Thank you, Mr. Secretary, for being here today.
As we have heard from you, our U.S. Government has imple-
mented aggressive measures to help prevent the spread of the
coronavirus. There have been repatriation missions. There have
been travel bans, airport restrictions, and additional travel notices
issued. Many of these actions have impacted Los Angeles County
and, in particular, my district.
On February 2, the President signed a proclamation banning for-
eign nationals who have traveled to China in the preceding 14 days
and were not the immediate family of U.S. citizens and permanent
residents. Over the course of a few weeks, 808 U.S. citizens were
flown back to the United States, where they were quarantined for
14 days at military bases.
As of today, 37 countries have confirmed cases of coronavirus.
Should we expect travel bans from countries, like Italy, who have
confirmed cases of transmission but are on a different continent
than current travel bans?
Mr. Secretary, how sustainable are quarantines and travel re-
strictions in holding the coronavirus at bay?
Secretary AZAR. It is an excellent question. And that is why,
when we did the initial 212(f) China ban that you mentioned, we
were very clear, we can’t hermetically seal the United States off,
and, at some point, there would be sufficient spread in other coun-
tries that measures like that would not be effective.
With China, of course, with the epicenter being in China and
with the aggressive measures taken by China, that is what we felt
was appropriate to do there. We will constantly look at other travel
advisories, 212(f) restrictions, or surveillance and requests for home
isolation as we gather more information. But it is a very fair point,
absolutely.
Ms. BARRAGÁN. And so, following up on that, what resources are
going to the quarantines that are happening?
Secretary AZAR. So——
Ms. BARRAGÁN. And should these be expanded? Should they be
extended? You know, what additional resources do you expect are
going to be necessary?
Secretary AZAR. So I would actually like to get us out of the Fed-
eral quarantine business. And I do want to commend California
and the local governments there. They have really been a superb
partner with us on the repatriation of American citizens. But it is
quite expensive to maintain institutional quarantine.
We don’t envision further repatriation flights that really has im-
plicated that need for us to scale up this type of facilities-based
quarantine. In the future, as I think Dr. Schuchat mentioned yes-
terday, we would envision more self-home-isolation activities,
State- and local-based monitoring and quarantine activities.
Ms. BARRAGÁN. OK.
I want to drill down a little bit on this, because on Monday HHS
issued a statement that revealed a Naval base in Ventura County,
Point Mugu, may receive American travelers coming through LAX
who would be quarantined to be monitored for symptoms of
69
coronavirus based solely on their travel history. Let me repeat that:
based solely on their travel history.
Mr. Secretary, what are HHS’s plans to quarantine Americans
based on solely their travel history? And would those be voluntary
or mandatory?
Secretary AZAR. So that would be the Hubei province travel. So
an individual who within, the previous 14 days, has been in Hubei
province in China, as an American or a permanent resident alien
or family member, would be subject to mandatory quarantine.
We are seeing very, very few of those individuals. I think we had
a family of three and then one individual is really all, I believe,
that we have right now currently in quarantine.
So that is more of a backup concept there, the Ventura facility
you are talking about, to know it is there. But we have, again,
worked very well with the State and locals in California.
Ms. BARRAGÁN. Right. And we certainly know that the CDC has
said that it is not a matter of if the virus is going to spread but
a matter of when. You know, Congress wants to work with your
agency to fund adequate and effective and sustainable public
health responses. We can’t do that without sufficient funding going
forward to appropriate to State and local partners.
Secretary AZAR. Yes.
Ms. BARRAGÁN. I know that you will be seeing out of the Con-
gress, especially out of the majority, a proposal on that.
Thank you, and I yield back.
Secretary AZAR. Thank you.
Ms. ESHOO. The gentlewoman’s time has expired.
The Chair recognizes the gentlewoman from New Hampshire,
Ms. Kuster, for her 4 minutes.
Ms. KUSTER. Thank you, Madam Chairman.
And, Secretary Azar, thank you for appearing before our com-
mittee. There is a lot going on both in your budget and with our
concerns about the coronavirus, so I will move through this quickly.
The key to a public health crisis, as you well know, is trust and
credibility. And my point is, it would be helpful for clear, easy-to-
understand, credible updates from this administration to both us,
as policymakers and Members of Congress, and to the American
people. And it would be even more preferable if the statements by
the President of the United States did not contradict the state-
ments of the scientists and physicians at the CDC and in your de-
partment.
My time is limited. I want to jump right in on the administra-
tion’s continuing efforts to undermine the Affordable Care Act’s
consumer protections for people with preexisting conditions.
The administration and your testimony today claims to support
protections for preexisting conditions, but, with all due respect, the
facts speak for themselves. This administration has repeatedly
taken action, including court proceedings, to undermine protections
for people, including my constituents, with preexisting conditions.
Your department finalized a rule to expand junk plans that do
not provide protection for people with preexisting conditions and
issued a 1332 waiver guidance creating new standards inconsistent
with congressional intent. The guidance allows States to increase
consumers’ costs, reduce coverage, and undermine protections.
70
Simple ‘‘yes’’ or ‘‘no’’ question, Secretary Azar: Are you aware
that the 1332 guidance could substantially raise costs for Ameri-
cans with preexisting conditions?
Secretary AZAR. Actually, our 1332 guidance allowed me to ap-
prove reinsurance waivers for 11 States, causing 10- to 30-percent
declines in premiums in the exchange market.
Ms. KUSTER. And in the other States, what would the result be?
Secretary AZAR. One other State was, I think—I forget if it was
Hawaii that we approved a waiver allowing them to not have the
SHOP. I think that was it, if I remember. Yes, in Hawaii. So that
was at their request, to not have the State—I forget the exact ter-
minology of what the SHOP is, but it is a technical aspect of the
Affordable Care Act.
We have approved no other ACA 1332 waivers at this point.
Ms. KUSTER. And will you commit not to approve waivers that
would jeopardize the health and well-being and the financial well-
being of Americans with preexisting conditions?
Secretary AZAR. You can’t waive the protection against pre-
existing conditions, under 1332 or otherwise.
Ms. KUSTER. And this administration is inviting States to make
changes to the ACA subsidy structure and direct taxpayer dollars
to junk plans. And those do indeed threaten and jeopardize individ-
uals with preexisting conditions.
Yes or no, do you think it is appropriate to allow States to direct
taxpayer dollars toward junk plans that do not provide protections
for preexisting conditions?
Secretary AZAR. We think it is appropriate to allow States to sup-
port access to these short-term, limited-duration plans, which are
plans that the Obama administration allowed to 12 months up
until the end of the administration.
Ms. KUSTER. Well, let me dive right into that. Under the Obama
administration, the short-term, limited-duration plans were for just
three months.
Secretary AZAR. I——
Ms. KUSTER. You have now extended it to 12 months with three
renewals. That is not the same condition.
Secretary AZAR. I am afraid that is actually not correct. The
Obama administration had them for up to 12 months up until the
very end of the administration, when they passed a midnight regu-
lation shortening it to three months.
Ms. KUSTER. To three months. That is my point.
Secretary AZAR. Right at the very end. They were perfectly fine
with the——
Ms. KUSTER. That is my point, is it was three months, and you
have allowed for extensions for up to three times. That is four
years.
And we had people testify here that they did not even have no-
ticed that their preexisting conditions were not covered, and even
insurers that said to them that if they didn’t know they had a pre-
existing that they should have known.
So this is something we need much more work on. I aim to pro-
tect consumers with preexisting conditions.
Thank you. I yield back.
71
Secretary AZAR. Just one correction. It is 12 reinsurance waivers,
not 11.
Ms. ESHOO. The gentlewoman’s time has expired.
The Chair recognizes the gentlewoman from Illinois, Ms. Kelly,
for 2 minutes.
And I just want to instruct the members; we have two more to
question, and they have agreed to limit their time to 2 minutes
each. We will then take a very short break, maybe 5 minutes, to
reset the witness table for the next panel and allow the Secretary
to take, you know, a few-minute break.
All right. So now we will recognize the gentlewoman from Illi-
nois, Ms. Kelly, for 2 minutes.
Ms. KELLY. Thank you, Mr. Secretary, for being here.
I wanted to talk about two issues that I have paid a lot of atten-
tion to and that have actually ravaged communities of color across
the Nation. One is maternal mortality, and the other is gun vio-
lence.
President Trump has expressed concerns about maternal deaths,
and, following mass shootings last year, he called for bipartisan so-
lutions to reduce gun violence. Well, we in Congress have come up
with bipartisan solutions for both. I have worked with my col-
leagues on the other side of the aisle on a bill to expand Medicaid
to provide postpartum coverage for a full year. And Congress ap-
propriated and President Trump signed into law $12.5 billion in
funding for the CDC to study gun violence.
Yet your administration seeks to slash funding to and block-
grant Medicaid, implement more restrictive eligibility criteria for
Medicaid recipients, and completely zero out funding for gun vio-
lence research.
Secretary, are you aware, yes or no, that the budget contains a
proposal that would allow States to impose an asset test on preg-
nant women in Medicaid? It is pages 112 to 113 of the HHS Budget
in Brief.
Secretary AZAR. I would want to look at that and get back to you
on that. I am not aware of that particular provision.
Ms. KELLY. OK.
Secretary AZAR. We do have the proposal, similar to what you
just mentioned for Medicaid, that would allow States an option to
cover pregnant women for one year after birth if they are suffering
from substance use disorder. So that is another part of the mater-
nal mortality initiative.
Ms. KELLY. Yes. That proposal will cut Medicaid’s funding by
$2.2 billion. That is because it would cause a lot of people, includ-
ing pregnant women, to lose their Medicaid coverage. So maybe
you——
Secretary AZAR. That is a spending provision, the one I just men-
tioned. It would actually expand—right now, they can only get 60
days’ coverage postpartum. This would allow that coverage for up
to a year as a State option in a non-budget-neutral way, I believe.
Ms. KELLY. Well, my time is up.
Ms. ESHOO. The gentlewoman’s time has expired.
That legislation that we took up here is awaiting floor approval.
The gentlewoman has been a leader on this for long before the rest
72
of the members even knew that we had this horrible statistic in our
country.
Last but not least, the gentlewoman from Florida, Ms. Castor, for
her two minutes.
Ms. CASTOR. Thank you, Madam Chair.
Mr. Secretary, the administration is urging the Federal courts to
strike down the Affordable Care Act in its entirety, including the
protections for more than 130 million Americans who have a pre-
existing health condition.
I think my neighbors back home would want me to relay to you
how dangerous that is, how angry they are about it. They do not
want to return to the days when insurance companies could dis-
criminate against them if they had asthma, a cancer diagnosis,
some other preexisting condition. They don’t want to return to the
days where an insurance company can cancel them if they get sick.
And I think the coronavirus now highlights the importance of
consistent health insurance coverage that has a floor of essential
health benefits. And it really shines light on these junk plans. Your
department has finalized a rule to expand the short-term, limited-
duration junk plans. They are not required to cover preexisting
conditions. You acknowledged that in your last budget hearing in
front of this committee.
And a couple of studies have come out recently, a Georgetown
Health Policy Institute study, one commissioned by Leukemia and
Lymphoma Society, that kind of highlight the abuses here.
Is the Department conducting any oversight on the abuses of
these junk plans, the abuses in marketing, and false promises? Are
you conducting oversight of these?
Secretary AZAR. So the short-term, limited-duration plans are off-
exchange, and so we don’t actually regulate——
Ms. CASTOR. Could you just say ‘‘yes’’ or ‘‘no’’ quickly? Be-
cause——
Secretary AZAR. We don’t——
Ms. CASTOR [continue]. The time is short.
Secretary AZAR. We don’t regulate them directly. They are sub-
ject to State insurance regulation.
Ms. CASTOR. You do not—so it is, like, hands-off? You said, we
are going to promote these junk plans, and you are not conducting
any oversight? Is that true, yes or no?
Secretary AZAR. They are subject to State insurance regulations,
as individual markets should be.
Ms. CASTOR. And you don’t check in with the State and monitor
the abuses in the junk-plan market that are raising costs on every-
body and excluding preexisting conditions?
Secretary AZAR. So we——
Ms. CASTOR. Thank you.
Secretary AZAR. We do not support—we do not regulate State in-
surance commissioners.
Ms. ESHOO. The gentlewoman yields back.
Let’s take a 5-minute break, and the staff can reset the witness
table, and then we will resume. Thank you.
[Recess.]
Ms. ESHOO. The Subcommittee on Health will come back to
order.
73
What we are going to do is, we are not going to have our wit-
nesses do their formal public statements. We have them all in the
record.
[The prepared statements follow:]
[The information appears at the conclusion of the hearing.]
Ms. ESHOO. We thank you for them. I have actually read them,
and I am sure my colleagues have as well.
What I just want to do quickly, out of respect to each, is to just
give a quick introduction. And then we will go to members with
their questions.
And, first of all, thank you for being here. I think that the
United States of America is so blessed—is so blessed—to have, I
think, the finest public health professionals in the entire world.
There is a reason why the world looks to us: Because we have you
and your expertise.
So, Dr. Fauci, thank you to you. America can’t live without you,
really.
Dr. Hahn, welcome to you. I think this is the first time that you
are before the committee?
Dr. HAHN. Yes.
Ms. ESHOO. And we will make it really pleasant for you.
Dr. HAHN. Thank you very much.
Ms. ESHOO. We won’t do to you what we did to the Secretary.
Mr. Secretary, welcome back to the table.
Dr. Kadlec, welcome to you.
And to Dr. Redfield from the CDC, thank you for being here.
And thank you, collectively, for what you have done to help to
brief the Congress during this.
Now, is it my turn to ask?
STAFF. Yes.
Ms. ESHOO. OK. Let me start, obviously, with the coronavirus.
I started out earlier today saying that confusion is the enemy of
preparedness. I do not put confusion at the doorstep of Dr. Fauci,
Dr. Hahn, Dr. Kadlec, and Dr. Redfield.
I think that you have done an excellent job in advising, briefing
the Congress and for the work that you are doing.
I think we have some problems with the administration, because
the professionals say one thing and then there is confusion on the
other side.
I hope that something else will happen, too, and that briefings
be held in public so the American people can hear you. I hope, as
we move through this challenge, that the American people will
come to know you the way we do, and that we elevate the level of
confidence and trust that I know you can engender, but I don’t
think it is there now.
There is confusion; markets are roiling. It is not only because of
confusion, but there are many matters at hand. But you, the sci-
entists, the doctors—the American people couldn’t be better served.
They just couldn’t be better served. So thank you to you for your
especially important service right now.
What I want to get to—Dr. Hahn, let me start with you—is our
drug supply. Are manufacturers being forthcoming with the FDA
about potential shortages?
Dr. HAHN. Madam Chairwoman, thank you for the question.
74
We are being very proactive in our discussions with manufactur-
ers. As you know, drug manufacturers are required to report to us
when there are potential disruptions——
Ms. ESHOO. And how far in advance do they let you know that
there will be a shortage?
Dr. HAHN. Typically those conversations occur in real-time. What
we have done is——
Ms. ESHOO. Well, I know that—I think, usually, all of our con-
versations are in real-time. I am saying, how much—you know, in
a trajectory of time, if they were talking to you today, would they
be able to tell when the shortage would begin? How much runway
do we have?
Dr. HAHN. We often do not——
Ms. ESHOO. For example, China and manufacturing. So we have
a problem with that.
Dr. HAHN. So, just as an example, I can tell you that drug manu-
facturers are required to tell us when there is a potential disrup-
tion to the drug supply. When the applicants apply to the FDA,
they might provide, for example, five different manufacturers for
the precursors to the drug and then five manufacturers for the ac-
tual final drug form——
Ms. ESHOO. OK.
Let me ask you this. If the coronavirus outbreak is continuing
three months from now—and I pray that it isn’t—what do you esti-
mate the American drug supply will be? Have you done——
Dr. HAHN. So we have looked at this.
Ms. ESHOO [continue]. Forward-leaning planning?
Dr. HAHN. There are 183 prescription drug manufacturers in
China. Twenty are sole-source from China. That is both precursors
as well as the final drug form. We have reached out to all of these
manufacturers, and we have no shortages to those sole-source
drugs.
It is the redundancy, Madam Chairwoman, that is most impor-
tant, and if we have redundancy, then we can shift to other manu-
facturing sources.
Ms. ESHOO. Yesterday, the FDA said that—you mentioned this—
the 20 drug products that are either solely sourced there for their
active ingredients or finished drug products from China. Can you
share that list with us, or is that proprietary?
Dr. HAHN. That is a proprietary list. We are internally compiling
lists associated with all the questions that we have been asking of
manufacturers.
Ms. ESHOO. Yes.
Dr. Redfield, how many coronavirus tests can the U.S. conduct
as of today?
Dr. REDFIELD. How many cases?
Ms. ESHOO. Yes. How many tests——
Dr. REDFIELD. Oh, tests.
Ms. ESHOO [continue]. Can our country conduct as of today?
Dr. REDFIELD. I would have to get back to you with the exact
number.
Ms. ESHOO. OK.
I kind of teased, but I was serious, Secretary Azar. We have
some deep cuts to these agencies, the people that you are sitting
75
with. And it was mentioned by, I think, the ranking member that
the budget was printed and it couldn’t be changed because of the
print and all of that.
I think, Secretary Azar, the $200 million in cuts at BARDA, $700
million in cuts at CDC, and $3 billion out of NIH, are you willing
to reconsider that, given what our country is facing and what the
American people need day-in and day-out from these agencies?
They are the essentials.
Secretary AZAR. The proposals to the budget do not impact our
ability to do the novel corona response. The CDC budget actually
has a $135 million increase in the fields of infectious disease and
global health security preparedness.
Ms. ESHOO. Do you think that, in other words, they deserve
these cuts? These are healthy cuts? This is good for them, and it
is good for our country.
Secretary AZAR. You asked me about impact related to novel
coronavirus. These will not impact functioning related to that. And,
of course, we have these emergency supplemental request on top of
that.
Ms. ESHOO. Well, but if you wrote it in December, how do you
know that?
Secretary AZAR. Because the changes that we make in the budget
are not related to categories that will impact our ability to do the
novel coronavirus response.
Ms. ESHOO. So there is nothing to reconsider?
Secretary AZAR. I don’t believe there is, in terms of the existing
budget proposal. We have——
Ms. ESHOO. Well, you know what?
Secretary AZAR [continue]. The emergency supplemental adding
to accounts that we think are the relevant ones.
Ms. ESHOO. Today is February 26, 2020, and I certainly hope you
are right, but I think that we are shortchanging the American peo-
ple.
At this time, I recognize Dr. Burgess, the ranking member of the
subcommittee.
Mr. BURGESS. I thank the Chair.
I would just point out, we are the United States House of Rep-
resentatives. All spending bills originate in the United States
House of Representatives. So it is certainly well within our power
to provide the level of spending that you all request.
The House is just now doing its budget, several months after the
administration did its budget. I will be testifying to the Budget
Committee tomorrow. I think if people have concerns, they ought
to bring them up to the Budget Committee. I just hope we will ac-
tually have a budget debate and vote on a House budget, because
we haven’t in several previous years.
But I do want to thank the panel for being here today. This is
critically important. The Chair is correct that people do need to see
and this needs to be public. That is why we have hearings, because
hearings are on the record and are public, which is why, several
weeks ago, I suggested we have this hearing, and I am glad we are
having it today.
Secretary Azar, you were testifying on the budget before. You did
take some questions on the issue of the Office of Refugee Resettle-
76
ment. Just off the topic of the corona, can I say, I have been fortu-
nate enough to visit a number of your facilities provided by Office
of Refugee Resettlement, and I think we are fortunate to have the
men and women who are working in those facilities. And would you
just please convey to them my thanks? Because I do think they do
a good job, and we would be much the worse without them.
Secretary AZAR. I will. And that will mean a great deal to them.
Thank you.
Mr. BURGESS. Dr. Hahn, you and I had talked a little bit, some-
what earlier, about the supply chain and the active pharmaceutical
ingredients that we import from overseas. And the fact was that
there was an adequate stockpile as, sort of, this story began to
evolve several weeks ago.
To the extent that you can tell us, how are things looking now,
as far as the stockpile that companies have available, as far as the
active pharmaceutical ingredient?
Dr. HAHN. Thank you, Representative Burgess.
As we discussed before, we have received no reports of shortages
and found no shortages in prescription drugs coming from China.
And we have discussed this with manufacturers and pharma com-
panies, and adequate supplies currently exist.
Mr. BURGESS. So can I just offer this observation? And I have
been on this subcommittee for a long time, and we have had this
discussion in other guises and other times. And if there is any sil-
ver lining to this cloud, it may be that we recognize that we need
to bring some of that manufacturing back within our own shores
so that we are responsible for our—we have the responsibility for
those active pharmaceutical ingredients.
And I know this is something the President is focused on and
part of his rebuilding of America. This is, I think, work that this
committee, subcommittee, has done in the past. I think it is some-
thing that we really need to take very seriously.
We had some hearings on continuous manufacturing a few weeks
ago, and I think that is another aspect of this, where—perhaps
some attention to the continuous manufacturing, but the main
thing is make it here so we are not dependent on a sole source from
another country. Whether it be in difficulty from an infection or
just simply out of sorts with the United States at the time, it does
jeopardize our people, and I do think we need to recognize that.
And, again, that is not a criticism of this panel. We have known
about that on this subcommittee for a long time, and it is just, we
haven’t acted. Now, perhaps we will.
Dr. Redfield, I would like to ask you, we have heard several
times the World Health Organization was able to finally get into
China and assist them. And now that report is going to be coming
back. Are you satisfied with the level of interaction that you have
had with your Chinese counterparts? Because the CDC itself was
not allowed to go in. Is that correct? It was only as part of the
World Health Organization?
Dr. REDFIELD. We were able to have a representative on the
GOARN team that went to China to do the investigation. I have
had regular conversations with my counterpart, the head of the
CDC in China. We have had a good exchange of scientific informa-
77
tion. We do have a CDC office in Beijing, China, that is there, and
they continue to have good interactions with those colleagues.
Mr. BURGESS. So you think there is, working with the State and
local folks?
Dr. REDFIELD. There is good scientific interaction between us.
Mr. BURGESS. OK.
And, Dr. Hahn, let me just come back to you for a moment. And
thank you for the work you are doing on getting a laboratory-devel-
oped test. That is critical. They can’t all be done at the CDC. We
are going to have to be able to get those tests done rapidly in the
field for our people on the front lines.
But is there any evidence if there is any sort of hoarding behav-
ior going on with things like personal protective equipment or
pharmaceuticals? Is that something about which we need to be-
come concerned?
Dr. HAHN. In terms of the supply for——
Mr. BURGESS. Yes.
Dr. HAHN. We have reached out to manufacturers, and we are
aware that spot shortages can and have occurred. However, cur-
rently, we know of no overall shortage related to PPE. However,
this is a very dynamic situation, as I mentioned at yesterday’s
press conference, that we are likely to see some pressure, particu-
larly on the demand side here.
Mr. BURGESS. Is there anything——
Dr. HAHN. We are working very closely with manufacturers on
this.
Mr. BURGESS. OK. Is there anything you can do to prohibit or
prevent—not prohibit, but prevent hoarding activity by people who
might just be buying up equipment?
Dr. HAHN. Well, the Department has led an all-Department ef-
fort to communicate to providers and hospitals regarding this issue.
And we have recommended following CDC guidelines with respect
to the use of particularly respirators, where it seems to be the most
pressure.
Mr. BURGESS. OK. Thank you.
Ms. ESHOO. The gentleman’s time has expired.
It is a pleasure to recognize the gentlewoman from Colorado, Ms.
DeGette, for her 5 minutes of questioning.
Ms. DEGETTE. I thank the Chair for including some of the other
subcommittees in this.
As four of the five of you well know, we have been having hear-
ings in the Oversight Subcommittee for years on these issues. It is
what keeps me up at night. The most recent hearing we had was
on December 4 about seasonal flu and pandemic flu. And lo, here
we are. And what I am concerned about is, we are still not any
more prepared than we were on December 4. And so that is what
I want to talk about.
Back in 2005, we had a National Blueprint for Biodefense—or
2015. Some of you recognize this document. Our now-colleague
Donna Shalala had your job, Mr. Secretary. And in this blueprint
for defense, what we they did was, they said, in case we have some
kind of a pandemic, we need to have a clear line of authority to
make these decisions.
Are you aware of that, Mr. Secretary?
78
Secretary AZAR. I wasn’t aware of Secretary Shalala’s rec-
ommendation in——
Ms. DEGETTE. But are you aware of this blueprint?
Secretary AZAR. More of the blueprint. I wasn’t aware of——
Ms. DEGETTE. OK.
Secretary AZAR. I wasn’t remembering that recommendation.
Ms. DEGETTE. Well, so this is what I want to ask you. Because
I just got back from Japan on Monday, and so we were really look-
ing at the Diamond Princess incident. And here is what I was con-
cerned about, is, you had all these people sitting in this petri dish
of a ship for a long time. The CDC said that people should not be
flown back to the U.S. from that ship. And then, apparently, the
CDC was overruled by the State Department.
So here is my question. You are the chairman of the President’s
task force on the novel coronavirus. Who is in charge? Are you in
charge?
Secretary AZAR. I am in charge. But in Japan, the Deputy Chief
of Mission, who is the Charge d’Affaires——
Ms. DEGETTE. Right.
Secretary AZAR [continue]. Who made that decision, has full au-
thority of the President of the United States——
Ms. DEGETTE. Right.
Secretary AZAR [continue]. When in a foreign country.
Ms. DEGETTE. So that is the problem.
Secretary AZAR. No, that——
Ms. DEGETTE. Well, yes, it is, and I will tell you why that is the
problem. Because you are the head of the panel, the health experts
are saying you shouldn’t be flying these people back in, and then
there is another agency that basically overruled what you said.
If we have an outbreak in the United States, there are a number
of other agencies that are going to have other interests. And I will
just give you a couple of examples: the State Department, which
we just dealt with; HHS is you; the State public health depart-
ments; various other agencies.
Who is in charge of the final verdict? Is it you?
Secretary AZAR. It depends on the circumstances. If it is——
Ms. DEGETTE. That is not going to work if we have a pandemic.
Secretary AZAR. No. If it is in a foreign country, the ambassador
of the President is the final word on representing the United
States’ interests in that country.
Ms. DEGETTE. So what happened is, they flew back in 14 Ameri-
cans, maybe more, who were infected with the coronavirus. That is
why someone needs to be in charge. And you know what? I think
it should be you.
Secretary AZAR. I just, with respect, I want to—the Deputy Chief
of Mission had a very difficult decision to make there. They——
Ms. DEGETTE. I understand that. I don’t need you to explain that
to me. What I am saying, as this goes along, there needs to be
someone who can overrule Homeland Security and State, who can
make these decisions for the American public based on public
health. And I am hoping we can have some more hearings to talk
about that.
Secretary AZAR. I appreciate that.
79
Dr. Redfield, I want to ask you—because the Chair, Chairwoman
Eshoo, asked you the question about the lab tests, and you said you
didn’t know how many lab tests are available—do we have lab tests
that will accurately test for the coronavirus?
Dr. REDFIELD. Yes. I——
Ms. DEGETTE. OK. Now, what I heard was they are limited, and
people have to send their tests to the CDC to be tested. Is that
right?
Dr. REDFIELD. Presently, there are 12 jurisdictions that have the
test up and running. Nine of——
Ms. DEGETTE. Twelve jurisdictions throughout the United
States?
Dr. REDFIELD. Throughout the United States.
Ms. DEGETTE. And so people can send their tests there?
Dr. REDFIELD. They send their tests there.
Ms. DEGETTE. And when are we going to be able to put that ev-
erywhere?
Dr. REDFIELD. Well, we are working cooperatively with——
Ms. DEGETTE. I am asking you, when are you going to be able
to put that everywhere?
Dr. REDFIELD. I was trying to say——
Ms. DEGETTE. Do you know?
Dr. REDFIELD [continue]. We are working with the FDA now. We
are hoping that later this week——
Ms. DEGETTE. OK.
Dr. REDFIELD [continue]. Our tests will be such that the first one
can go—all the laboratories that got it can execute the current test
on the modification that we did with the FDA.
Ms. DEGETTE. OK.
Dr. Fauci, I know you are working on developing a vaccine. If we
gave you more money, could we develop a vaccine more quickly?
Dr. FAUCI. We would need more money to take it for the next
step. We are in a Phase 1 right now, and we are OK. When we get
to——
Ms. DEGETTE. How much more money? How much more money?
Dr. FAUCI. For?
Ms. DEGETTE. I think you could probably get bipartisan con-
sensus that we would give you the money.
Dr. FAUCI. Yes. How much would you need for it to get it over
the hill?
Ms. DEGETTE. Yes. Yes.
Dr. FAUCI. About $140 million.
Ms. DEGETTE. $140 million. I think——
Secretary AZAR. And, Congresswoman——
Ms. DEGETTE. Yes?
Secretary AZAR [continue]. If you wouldn’t mind, the emergency
supplemental would actually dedicate a billion dollars for vaccines.
That is part of the detail we will be working with the committee
on.
Ms. DEGETTE. OK.
I just want to say one more thing, because my time is up, and
I know that Congresswoman Schakowsky is going to ask you some
questions about the supplemental. I just want to say that even Mi-
nority Leader McCarthy today said we need at least $4 billion. And
80
we shouldn’t be shifting money away from Ebola and other diseases
into trying to deal with this coronavirus. We need to work on all
fronts at once.
And I thank you for your comment.
And I yield back.
Ms. ESHOO. The gentlewoman’s time has expired.
The gentleman from Kentucky, Mr. Guthrie, is recognized for his
time.
Mr. GUTHRIE. Thank you, Madam Chair.
And thank you for all being here.
And just so everybody knows, we have been having these meet-
ings, if they have not been formal hearings, bipartisan, with sev-
eral of you over time. And I remember, when we first started meet-
ing about this, it might have been Dr. Fauci said—I don’t want to
put words in your mouth, but we were going to prepare for a pan-
demic. That is what the American people expect us to do. We are
going to prepare for a pandemic. We are going to put things in
place for a pandemic and hope and pray that it never comes. We
are going to get ready. And as we prepare for it, people are going
to see things, hear things, and maybe react that this pandemic is
imminent, when it may not be, because we are doing what we are
supposed to do.
The other thing is, I know the White House and the administra-
tion needs to reassure markets and marketplaces where we are and
where we stand. And for everything that I have heard previously
and what Larry Kudlow has said, it is not inconsistent with where
we are.
But I know that the CDC came out and talking about the pan-
demic, to be ready for it. And, Secretary Azar, if you would like to
explain this. I know the CDC warned that Americans should—and
I will quote—‘‘prepare for community spread’’ in the United States
and should be ready for, quote, ‘‘significant disruption.’’
And would you explain what that means and what it means to
the average person, what that means? And what is the most impor-
tant message you would like for the American people to know
about the current state of America and the coronavirus?
Secretary AZAR. Our messaging, from the President through to
the career officials at the CDC, has been consistent, but it is strik-
ing a balance: America’s risk is low at the moment. That could
change quickly. We are working to keep that risk low, but we have
always been transparent that we expect more cases in the United
States with a rapidly spreading virus, especially with what we
have seen.
For the average American, there is no change in their behaviors
except what we always would advise, which is: to practice good
public hygiene—washing your hands appropriately, coughing into
your arm, not touching your face with unwashed hands—and ap-
propriate preparedness activities at home. And you can go to
CDC.gov for normal advice for flu seasons, hurricanes, and others.
Good preparedness, and good thoughtfulness at home.
We are trying to be very transparent to people of the risks we
face, even if we are at a low-risk situation now, so people aren’t
surprised, so that they know what we are dealing with and what
uncertainties we are dealing with.
81
Mr. GUTHRIE. Thank you.
And so, Dr. Fauci and Dr. Redfield, for 50 days, we have learned
much about the coronavirus, but much is still unknown. What is
the current—this is what I know people want to know at home.
What is the current scientific consensus about the transmissibility,
infectiousness of the virus? And how long, once you are infected, if
you are infected, how long can you pass it on?
And what are the other remaining known unknowns? What are
the things you know that you would like to know the answer to?
With Dr. Fauci and Dr. Redfield and Dr. Kadlec, if that is in
your world.
Dr. FAUCI. Well, first of all, we know it is a very transmissible
virus. There are some viruses that are not efficient in going from
human to human. What we learned early on and we are convinced
now, given what we have seen in China and other countries, that
it is a highly transmissible virus. That is the first thing.
The second thing, when you say how long a person is infected
after they get infected, that is something that is still up in the air.
And the way you get the answer to that is you try and isolate the
virus, what we call, shedding for a period of time.
And we know that there are individuals who are actually able to
transmit when they are without symptoms, before they get symp-
toms. What we don’t know yet—and I think we are going to get in-
formation from the group, including the CDC individual and one of
my people who was in China with the WHO group—what the ex-
tent of that transmissibility is from an asymptomatic person. Is it
minor, part of the driving of the outbreak, or is it significant? That
is going to be a very important thing that is currently an unknown.
And, Bob, do you want to take over?
Mr. GUTHRIE. Dr. Redfield?
Dr. REDFIELD. I concur with Dr. Fauci. I think the biggest chal-
lenge we have right now is, what is the relative infectivity, whether
before you get sick—are you more infectious before you get sick, or
are you more infectious after you get sick?
We are tracking these patients that we do have in this country
to see how long they actually have a virus that can be isolated from
their respiratory secretions. It is probably going to be longer than
many of us originally anticipated. I think, at this stage, we have
an individual who is out about 18 days from the time they initially
actually got sick.
So I think these are key questions, and we continue to try to get
the data to answer them.
Mr. GUTHRIE. So are there other things that you are looking to
know that you don’t—that you know that you don’t know that you
are trying to find the answers to?
Dr. REDFIELD. Well, I think one of the other areas from the
CDC’s point of view is trying to understand the methods of trans-
mission. Is it all respiratory transmission through droplets? Is
there fomite transmission? For example, can this virus survive on
certain surfaces long enough for somebody else to come down, put
their hand down, and then touch their face? You know, it is not
clear right now what the relative components of, say, droplet trans-
mission is to fomite transmission.
Mr. GUTHRIE. Thank you.
82
My time has expired. I will yield back.
Ms. ESHOO. The gentleman yields back.
The gentlewoman from Illinois, Ms. Schakowsky, is recognized.
Ms. SCHAKOWSKY. Thank you.
As all of you know, the World Health Organization has declared
the coronavirus outbreak is a global health emergency, and our ad-
ministration now has declared it a public health emergency. Yet,
Secretary Azar—we have talked about this, you have heard about
it—the Trump administration asked Congress for just $2.5 billion
to combat the disease that the CDC’s Director, Nancy Messonnier,
warned could severely disrupt daily life and could cause severe ill-
ness in the United States.
So, in that request, you did not, as I understand, include—were
not specific about surveillance for testing kits that actually work—
because not all of them have—and for treatment. Instead, you sug-
gested robbing $500 million from the United States response to the
Ebola epidemic, which actually still is raging in places. So I find
it incomprehensible that you are asking for a molehill when what
we really need is a mountain of support here.
Secretary Azar, yes or no, do you agree with the President of the
United States that the coronavirus is ‘‘very much under control’’ in
the United States, unquote, and will, quote, ‘‘go away,’’ unquote, by
spring?
Secretary AZAR. He did not say the last part that you just said.
He said we hope it will go away with warmer weather. I hope ev-
erybody here would hope it would go away with warmer weather.
The virus in the United States has been in a contained situation
to date, but that can change. As Dr. Messonnier said, we expect
more cases, and we expect that we will see at least limited commu-
nity transmission of the virus in the United States.
Ms. SCHAKOWSKY. Let me ask you another question. My home-
town of Chicago reported the first human-to-human transmission of
the coronavirus in the United States. And though the Illinois and
Cook County and Chicago Departments of Public Health have
expertly, I would say, handled our two coronavirus cases; they have
not received any reimbursement or financial assistance for the
work they have done. I just met with the director of public health
in Chicago, who said they are spending $150,000 per week to re-
spond to this.
Will the United States be able, in the $2.5 billion, to help local
and State health officials who have already spent lots and lots of
money trying to deal with this?
Secretary AZAR. So, yes, that is actually part of the supplemental
request, is to fund State and locals. In addition to the $675 million
FEP money they already have received for many years, Illinois, of
course, received each year $16.3 million for exactly these activities.
But we want to give additional funding through the supplemental
request for those activities.
Ms. SCHAKOWSKY. Well, that is really good news. Thank you.
Secretary Azar, will your $2.5 billion be enough to help
healthcare workers in hospitals and nursing homes or the home-
care workers who have to care for quarantined individuals?
Secretary AZAR. In what respect are you asking?
Ms. SCHAKOWSKY. Well, I mean——
83
Secretary AZAR. The salaries? Because they are already paid. I
am just curious. I want to——
Ms. SCHAKOWSKY. No, I mean, I think——
Secretary AZAR. If there are elements we need to add to our re-
quest, we will be glad to——
Ms. SCHAKOWSKY. There may be a lot of additional costs that—
people that work in hospitals, and they may have to hire more peo-
ple. Is there any help that is going to be for staffing?
Secretary AZAR. Would you mind if Dr. Kadlec responds, Con-
gresswoman?
Dr. KADLEC. I can address part of your question, ma’am, and
that is, $350 million is dedicated for personal protective equipment
that could be used by healthcare workers in many different set-
tings. So we are stockpiling that to make it available should com-
munities need that in addition to what they have on hand.
Ms. SCHAKOWSKY. OK.
Let me just finally say this. Last week, 45 of my colleagues and
I sent a letter to President Trump, and what we were talking about
is, are we going to be guaranteed affordable treatments or vaccines
that are developed?
We are concerned that private pharmaceutical companies may
end up having a role in this and raising the cost beyond the point
that people could well afford it.
Secretary AZAR. We absolutely share your passion around ensur-
ing affordable access to medicines, but the private sector must have
a role in this. We will not have a vaccine; we will not have thera-
peutics without the private-sector candidates that they and we will
have to invest in.
Ms. SCHAKOWSKY. But we have paid for all the R&D so far,
right?
Secretary AZAR. No, that is not accurate. For instance, Gilead
has a product, Remdesivir, that was originally NIH-funded basic
research, I think, out of the University of Alabama, but they have
carried forward with development. Moderna is using Dr.
Fauci’s——
Ms. SCHAKOWSKY. My time has expired, but if I could just reaf-
firm then, you are saying it will for sure be affordable for anyone
who needs it?
Secretary AZAR. I am saying we would want to ensure that we
work to make it affordable, but we can’t control that price, because
we need the private sector to invest. The priority is——
Ms. ESHOO. The gentlewoman’s time has——
Secretary AZAR [continue]. To get vaccines and therapeutics.
Price control won’t get us there.
Ms. ESHOO [continue]. Expired, Mr. Secretary. Thank you.
I now recognize the gentleman from Michigan, the former chair-
man of the full committee, Mr. Upton.
Mr. UPTON. Thank you, Madam Chair.
I have a couple of questions that I hope to run through. And I
guess the first question ought to be directed to—first of all, thank
you all, 24/7, and for the briefings that we have had over the last
couple of weeks as well.
I guess this ought to be directed first to Dr. Redfield. There is
a report just published now in the last hour or two of apparently
84
there is a daily newspaper in Korea called the JoongAng Daily, and
they reported that there is a Korean Airlines flight attendant who
serviced a number of flights between LAX and Seoul, and she was
confirmed to have coronavirus. They are not sure where she got it.
There is some suspicion that she had also worked a flight to Israel
with that apparent tourist group that came from Korea there in the
previous week.
What do you know about this? Is there some communication? I
hope you know something, but I know that it is recent news. But
it was published Tuesday in Korea; it is Thursday now. So just
wondering what you might know about this.
Dr. REDFIELD. I can say that I haven’t been briefed on that, sir.
Normally what we would do, if we had confirmed cases, obvi-
ously——
Mr. UPTON. Now, this is a Korean woman, 24 years old.
Dr. REDFIELD. Yes. So that would be—we are interacting—we ac-
tually sent someone yesterday to embed in the Korean CDC to help
facilitate communications between Korea’s CDC and our CDC. But
I can tell you I haven’t been briefed on that specific situation. But
I will look into it and get back to you.
Mr. UPTON. OK.
And, second—and does anyone else know anything more?
Dr. Fauci, I know that China did publish, thank goodness, the
genetic sequence, which has allowed the rest of the world to try
and pierce the bubble here. Moderna Therapeutics is one of the
companies—I think they are out of Massachusetts—that is actually
working on, I want to say, a Phase 1, but I may be wrong.
Dr. FAUCI. Yes.
Mr. UPTON. If it is successful, how long? What can you tell us?
Dr. FAUCI. We are working with the company Moderna on a vac-
cine platform called messenger RNA. We are working at our Vac-
cine Research Center.
And we did exactly as you said. As soon as the sequence was put
on a public database, we pulled the gene out for the spiked protein,
which is the protein that you want to make an immune response
against.
There are several steps in that that determine the success or fail-
ure of what you are doing. And we have been able to successfully
express it in this particular platform that we are going to use for
a vaccine. We have shown that it is immunogenic in mice. And very
soon, within the next month and a half to two, it is going go into
humans in a Phase 1 study.
But I think people need to appreciate—because there is often
misunderstanding—a Phase 1 study, we will say, was three months
from the go, which was about a month and a half ago. It will take
about three months or four to determine if it is safe and induces
the kind of response that you would predict would be protective.
Once you get there—it relates to the question that I was asked
before—then you go to a Phase 2 study. The Phase 1 study has 45
people. A Phase 2 study has hundreds or maybe even low thou-
sands of people. That would take at least six or eight months to
show that it works. So, from the time you push the button to go
to the time you even know it works, it is about a year to a year
and a half.
85
Then, as the Secretary said, you have to partner with pharma-
ceutical companies to make millions and millions and millions of
doses, which could also extend the time.
Mr. UPTON. And that would be a vaccine or a remedy?
Dr. FAUCI. That would be a vaccine——
Mr. UPTON. OK.
Dr. FAUCI [continue]. To prevent infection.
Mr. UPTON. OK.
The last question that I have, and I will save this for Secretary
Azar. A couple of weeks ago, my colleague Debbie Dingell and I
sent a letter to the administration—you were copied on it—as it re-
lates to the supply chain of companies with operations in China,
specifically Wuhan province.
A lot of us are concerned about products that are made there.
Auto State, Michigan, we have a lot of different things that are
there. I know Apple, as an example; they fessed up; their stock
price collapsed and led to the market trouble that we had this
week.
What type of outreach are—have you initiated outreach to com-
panies large and small, particularly on the shortage questions as
well? Because they may not want to tell you what they might
know. Where are you all on that?
Secretary AZAR. So, as chair of the task force, we have directed
a whole-of-government outreach to manufacturers and suppliers
across not just healthcare but everywhere. And Dr. Hahn and Dr.
Kadlec have led the effort with regard to pharmaceutical, generic
and biologic, and device manufacturers in China.
And that is what Dr. Hahn was reporting on earlier, the results
of that outreach. Very proactive. As you know, with drugs, they
have to report to us potential shortages. Device, we don’t yet have
legislation on that, so we are proactively probing that system. As
he reported, we don’t yet know of any potential shortages, but we
are on that because we share your concern about the risks there.
Mr. UPTON. Just to follow up, is the Secretary of Commerce—are
they working on other things——
Secretary AZAR. Yes.
Mr. UPTON [continue]. Beyond just drugs and devices?
Secretary AZAR. Yes. With their regulated entities and their
major manufacturing entities, they are working to gather informa-
tion about potential shortages, as they might impact the economy.
The National Security Council and the National Economic Council
are leading those efforts.
Mr. UPTON. Thank you.
I yield back.
Ms. ESHOO. I appreciate what Mr. Upton raised overall but cer-
tainly the last part of it, the whole issue of our dependence on
China and that 90 percent of the American people take generics
and that those generic drugs are manufactured in China and, to a
lesser degree, in India, but China controls the global market on the
API, the active pharmaceutical ingredients.
But I met with Dr. Kadlec after—I think it was the classified
briefing. He came to my office. What I wanted to know was, do we
have an inventory? Do we have an inventory of who the manufac-
turers are? Are any of these plants shut down? I know we asked
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questions about how long they can manufacture until they can’t,
because drug shortages are a part of this whole problem with the
supply chain.
But when I met with Dr. Kadlec, we don’t have that inventory.
Is that in place now Mr. Secretary?
Secretary AZAR. Actually, I believe——I believe that is what Dr.
Hahn briefed you on earlier.
Ms. ESHOO. We do have an inventory?
Dr. HAHN. We have reached out to the manufacturers. We have
to do that proactively because there are not requirements, for ex-
ample, state of operations that are required to report to us.
Ms. ESHOO. But if we inspect manufacturing plants, don’t we
know who they are?
Dr. HAHN. Yes, we do.
Ms. ESHOO. Don’t we have a list of them?
Dr. HAHN. Yes, we do.
Ms. ESHOO. We do.
Dr. HAHN. Yes, we do.
Ms. ESHOO. What is the difference between that and the question
I asked then?
Dr. HAHN. So we have a list of manufacturers that have been
given to us by pharmaceutical companies who manufacture both
precursor products and final drugs in China. But there may be five
or six for each of these drugs, and they might be in different coun-
tries.
Ms. ESHOO. I see. All right.
The gentleman from Massachusetts, Mr. Kennedy, is recognized
for his 5 minutes.
Mr. KENNEDY. Thank you.
I want to thank you all for being here. Thank you for being will-
ing to be before this committee. I have some differences with some
of you up there on our healthcare policy, but I am grateful for your
presence here, and I wish you all success. So good luck to you, and
good luck to us all.
First off, a bit of—just rapidly, sir, Dr. Redfield, if you can. I
have a 2-year-old and a 4-year-old, and a lot of other parents of
young children are nervous about this. Can you just give me a real
quick answer, as to parents of young kids, is there anything people
should be doing at this point or should be concerned about?
Dr. REDFIELD. I want to echo what the Secretary said. Right
now, the risk to the American public is low, and we would argue
that they go on with their life. Our containment strategy has been
quite successful.
But that said, what was said also is that, in light of what has
happened in the Republic of Korea and Italy and Iran and Japan
and we have seen how fast this virus can move, we are encouraging
people, again, to just think about being prepared.
Mr. KENNEDY. OK.
Part of being prepared is trying to make sure that there is as
much and as clear communication as to what we are confronting
and how the government is structured to be ready for this and to
meet this challenge.
I do think, obviously, as some of my colleagues have noted, that,
despite calls to strengthen our country’s pandemic preparedness,
87
this administration did dismantle the Federal Government’s pan-
demic response chain of command, including leadership structure
at the White House through the National Security Council’s global
health security unit.
So when you flash-forward to this year and the coronavirus
starts spreading throughout the world, there have been reports of
this task force—and, Mr. Secretary, you indicated that you are, in
fact, the head of it. I would ask just, if you can, to the greatest ex-
tent possible, communicate what that structure looks like so that
people can have some understanding as to what is backing that up.
You don’t have to do it now, but just as you can. Just to get that
information out would be helpful to all of us.
So, moving on a bit, though, to try to make sure that there is
not just a structure put in place but that communication is, in fact,
clear, Mr. Secretary, I would take a bit of an issue with the fact
that the message is consistent. I think the message from you all
up here on this panel, so far has been pretty consistent. I do have
an ABC News story here that I am going to enter for the record
which quotes the President as saying that it is, quote, ‘‘a problem
that’s going to go away,’’ end quote.
The President is also quoted as saying, quote, ‘‘The virus we’re
talking about having to do, you know, a lot of people think it goes
away in April with the heat, as the heat comes in. Typically that
will go away in April. We are in great shape though,’’ end quote.
Dr. Fauci, does this go away in April with the heat?
Dr. FAUCI. The history of respiratory viruses such as influenza
and other coronavirus viruses tends to diminish and almost dis-
appear as you get into the summer. That is just something that
happens. Every year, we see that with influenza.
However—underline ‘‘however’’—this is a new virus, so we don’t
know what this virus is going to do. If it acts like influenza, the
heat will actually make it diminish in its impact. But we have no
way of knowing how it is going to act.
Mr. KENNEDY. And I would say that there are different tempera-
ture gradients across this country by April. Fair enough?
Dr. FAUCI. Correct. And also in different hemispheres, because
when we are having cold weather, others are having warm, and
vice versa.
Mr. KENNEDY. Thank you.
He has also stated that we are, quote, ‘‘very close to a vaccine,’’
end quote. But, Doctor, you just laid out that, best-case scenario,
we are still 12 to 18 months away roughly. Is that right?
Dr. FAUCI. Correct.
Mr. KENNEDY. He said—congressional staff briefed folks yester-
day in a press conference. Said, quote, ‘‘It’s not a question of if but
rather a question of when and how many people in this country
will have severe illness.’’ Almost at the exact same time, the Presi-
dent was saying that, quote, ‘‘it’s going work out fine,’’ end quote,
‘‘a problem that’s going to go away.’’
Dr. Redfield, does the CDC agree that this is a problem that is
going to go away without intervention?
Dr. REDFIELD. I think it is important to recognize that, from time
to time, new pathogens come from animals and get into the human
species. Clearly, this is one of those times when we have a new res-
88
piratory pathogen that has come into the human species. And I
think it is prudent to assume that this pathogen will be with us
for some time to come.
Mr. KENNEDY. Dr. Kadlec?
Dr. REDFIELD. And as——
Mr. KENNEDY. Dr. Kadlec?
Dr. REDFIELD. [continue]. Tony said, we don’t know the cycle of
it. We don’t know how it is going to—if it is going to be impacted
by humidity and heat. But I think we should assume that this
virus is going to be a virus that we are going to be challenged with,
similar to the other viruses that we have that are respiratory.
Mr. KENNEDY. Doctor, thank you.
I have ten seconds left. For the rest of the panel, ‘‘yes’’ or ‘‘no,’’
agree with Dr. Redfield?
Mr. Kadlec?
Dr. KADLEC. I support Dr. Redfield’s view.
Mr. KENNEDY. Mr. Secretary?
Secretary AZAR. The President is expressing confidence that this
team, the public health infrastructure in this country, State and
local, that we can deal with this. We will prepare for this. We will
work together on this. He is trying to calm the public.
We see in China that panic can be as big of an enemy as the
virus in these situations. And so there is always that balance——
Mr. KENNEDY. Mr. Secretary, I don’t want to panic over this ei-
ther. The stock market is crashing. He is trying to stop the stock
market. He is not trying—he is outright contradicting everything
that you all have just said. Outright contradiction.
Secretary AZAR. I think he is expressing confidence in——
Mr. KENNEDY. With no medical basis for it. That is what you
have just expressed to us. Come on, sir.
Secretary AZAR. Well, no. He is expressing that the American
people need to take a breath here, that there is no change to any-
one’s daily life from this, that the country has a plan, we have pan-
demic plans, there is a playbook for this, and we are executing
against that. But we have to be realistic, also, and transparent that
we will have more cases——
Mr. KENNEDY. And, sir, as head of HHS, do you agree with the
President’s statement, as I quoted, ‘‘The virus that we’re talking
about having to do, you know, that it will go away with the heat’’?
Ms. ESHOO. The gentleman’s time has expired.
Do you want to answer that quickly?
Secretary AZAR. No.
Ms. ESHOO. No. I didn’t think so. You are doing a great job for
the President, Mr. Secretary.
It is a pleasure to recognize the gentlewoman from Indiana, Mrs.
Brooks, for her time.
Mrs. BROOKS. Thank you, Madam Chairwoman.
And thank you all so very, very much for being here and for your
work day-in and day-out on behalf of not only our country but on
behalf of the world.
And I would like to remind my colleagues that in November of
2019 the United States of America was ranked number one in glob-
al health security. The Global Health Security Index, conducted by
Johns Hopkins, of 195 countries, we are leading the world.
89
Now, that doesn’t mean that we can’t always continue to im-
prove. And that is what PAHPA, which was passed, signed into law
in June, did. It actually took care—it focused on vulnerable popu-
lations, like children, like the elderly. We added a lot of new things
to that.
One of the things, though, that I am concerned about is the flexi-
bility of the funding and whether or not—we introduced an Infec-
tious Disease Rapid Response Reserve Fund. Eighty-five million
was put into that fund. We have $705 million in a Strategic Na-
tional Stockpile fund. We have all of these.
How much flexibility is there? Or do we need to give you more
authority, Mr. Secretary, very quickly, to have more flexibility to
be able to not focus on Congress having to do supplementals all the
time? How much more flexibility do you need?
Secretary AZAR. Well, the Infectious Disease Rapid Response
Fund has been critical for us. The flexibilities in the Strategic Na-
tional Stockpile, is critical to us. The emergency supplemental, is
the most flexibility that you could give us there; as we deal with
the situation as it evolves, we would appreciate that also.
The challenge with setting up long-term funding mechanisms
that are indefinite is they can become slush funds for any other
priority, as opposed to concrete, real public health emergencies. I
think that has always been the challenge.
Mrs. BROOKS. And if you find that you need more funding for any
of these funds, will you come back and ask for more funding?
Secretary AZAR. Absolutely. And I want to emphasize, the 2.5 is
at least 2.5. It is for 2020 only. And we will come back if we need
more. And we will work with Congress if Congress wishes to give
more.
Mrs. BROOKS. Dr. Kadlec, with respect to the Strategic National
Stockpile, which I believe you oversee in conjunction with the
CDC—is that correct?
Dr. KADLEC. Yes, ma’am.
Mrs. BROOKS. What is the status of our Strategic National Stock-
pile?
Dr. KADLEC. Well——
Mrs. BROOKS. Can you quickly say what those are?
Dr. KADLEC. Sure. It is a variety of countermeasures that deal
with chemical, biological, radio, and nuclear capabilities, as well as
for pandemic influenza. We have a supply of personal protective
equipment that we have on hand. We have sent out a solicitation
to get more, but the answer is, we have a whole range of things
that——
Mrs. BROOKS. And these are at undisclosed locations——
Dr. KADLEC. Yes, ma’am.
Mrs. BROOKS [continue]. Throughout the country, are they not?
Dr. KADLEC. That is correct.
Mrs. BROOKS. And, at this point, is the Strategic National Stock-
pile sufficiently funded?
Dr. KADLEC. Ma’am, I think the thing is, at this point in time,
in light of what the requirements are, we have been given, at least
in terms of what is in the supplemental request, another $400 mil-
lion, that would be a great benefit to help us address any kind of
shortfalls for this event.
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Mrs. BROOKS. Last week, when I was home, I learned from a
local public health official in Indiana that an individual from this
county had traveled from China and, interestingly enough, had
come through the Chicago airport. And the Chicago airport officials
notified this public health official, said this person is coming home
to quarantine, and she appeared at this individual’s home within
24 hours of that person coming through the Chicago airport.
I thought that was awesome. It was excellent that that kind of
coordination happened. How did that happen? And is that hap-
pening all across the country?
And this individual is going to cooperate with the local health of-
ficial, and provide their temperatures for a couple of weeks. Is this
happening all across the country?
Dr. REDFIELD. Yes.
Mrs. BROOKS. And who at the airports is notifying local health
officials?
Dr. REDFIELD. So what happened, when the original travel re-
strictions were put in for China and Hubei, if you were coming into
the United States, an American citizen or a family member or a
permanent resident, on Hubei, you were required to go into 14 days
of quarantine. That quarantine could either have been institutional
or that quarantine could have been in your home, working with the
health departments. And that is really how we have
operationalized.
But if you had been from China, the requirement was that, when
you came through; you were screened. You were given an education
card, provided that you had no symptoms, telling you about the
risk and what the symptoms are and the contact information with
your local health department. And you, in conjunction with your
local health department, were going into what we called voluntary
monitoring and isolation.
And that woman that you gave the example of did exactly as we
instructed and they were instructed as they went through Chicago
O’Hare Airport.
Mrs. BROOKS. And so, actually, it was my local public health offi-
cial that was incredibly impressed that she had received this infor-
mation. The young man and his family are monitoring.
Madam Chairwoman, I would like to enter into the record—CSIS
produced a report in November of 2019 about U.S. global health se-
curity, making sure we are ending the cycle, with a number of rec-
ommendations. You and I serve on that commission. I would ask
that that be entered into the record.
Ms. ESHOO. So ordered.
[The information appears at the conclusion of the hearing.]
Mrs. BROOKS. With that, I yield back.
Ms. ESHOO. The gentlewoman yields back.
The gentleman from California, Mr. Ruiz, is recognized for 4
minutes.
And for those that are left, there is an agreement that it is 4
minutes because the panel is getting nervous about time. So let’s
honor that, OK? Thank you.
Mr. RUIZ. Thank you for being here today.
I want to discuss a very important issue for local agencies and
that I know many other members are hearing as well, and that is
91
funding and reimbursement for moneys that our counties and pub-
lic health departments have spent up front to help fight the spread
of the coronavirus.
I am a disaster-trained emergency physician, and public health
expert. And in disaster or epidemic preparedness, rapid reimburse-
ment is a matter of readiness capacity.
I think we can all agree that a lot is being asked from the public
health infrastructure in our States. They are stepping up. They are
coordinating. They are doing the right thing.
On January 29, a flight carrying 195 Americans from Wuhan,
China, was diverted to March Air Reserve Base in Riverside Coun-
ty, the county that my district is in. Riverside County responded
efficiently and was effective in monitoring and quarantining all of
these passengers for 14 days.
Over 40 county officials worked on this project. In addition, the
county supplied food, transportation, quarantine supplies, screen-
ing, housing, a mobile health clinic, emergency management stand-
by, and support services for ambulances. All told, these efforts are
estimated at a little over $1.3 million.
And while that flight quarantine is over, the broader response
continues in Riverside and in communities across the country. So
receiving rapid reimbursement is critical to capacity readiness in
the future. If you drain resources without replenishing them, you
won’t have necessary resources to fight this public health crisis,
such as bedside diagnostics, personnel, and masks, just to name a
few, and also having the resources to create preparedness plans,
quarantine plans, et cetera, in the case of rapid transmission of
this virus in the future.
So I want to ask a question. Dr. Redfield, what are the funds
that are available to reimburse State and local officials for their ef-
forts in responding to coronavirus?
Dr. REDFIELD. I will defer some of this to the Secretary, but I
think he said, in the supplemental, a substantial portion——
Mr. RUIZ. OK. So you are telling me—the last time we spoke, you
identified—somebody in your staff mentioned a few. Now you are
saying those funds don’t exist; we need to pass the supplemental
to reimburse counties. Is that what I am hearing from you?
Secretary AZAR. So we have the FEP, which funds California at
$41 million a year, but the supplemental has requested $757 mil-
lion from CDC——
Mr. RUIZ. OK. So which funds——
Secretary AZAR [continue]. Which would have in that the State
and local funding——
Mr. RUIZ. OK. Are there funds right now that counties can apply
for?
Secretary AZAR. No, there are not. That is what the emer-
gency——
Mr. RUIZ. There are no funds?
Secretary AZAR. No additional to the emergency——
Mr. RUIZ. OK.
Secretary AZAR [continue]. Funds that they get each year for
these activities.
Mr. RUIZ. All right.
Secretary AZAR. That is what the supp is for.
92
Mr. RUIZ. Well, we are definitely——
Secretary AZAR. We agree.
Mr. RUIZ [continue]. Going to work on that. And that is an issue,
right? Because we were under the impression that there were. And
rapid reimbursement is a matter of readiness capacity. If we don’t
rapidly reimburse, our local agencies will not be ready to deal with
a potential rapid spread of the virus.
Dr. Kadlec and Dr. Redfield, yes or no, can we get a commitment
from you both here today that you will reimburse these expenses
by local municipalities for the costs associated with containing the
spread of the coronavirus?
Dr. REDFIELD. Well, we are clearly going to work to see how to
get that done.
Mr. RUIZ. OK. So that is not a commitment.
Dr. Kadlec?
Mr. KADLEC. I think the thing is, we are committed to basically
work with you to do that.
Mr. RUIZ. OK. Well, we need to reimburse because, especially in
rural areas, where they don’t have the resources, they don’t have
the hospitals, the quarantine spaces, the ability to get the supplies
over to those areas, you are putting them in vulnerable situations
if you don’t respond.
Dr. Redfield, since 2008, local and State health departments
have lost nearly a quarter of their workforce. Does this affect our
Nation’s ability to mount and sustain a response?
Dr. REDFIELD. I think it is one of the key core capabilities that
we need to continue to improve for our public health ability—that
is, the data modernization, which you all have helped with last
year; the laboratory capacity, to build it and keep it fluid, as you
see with the current diagnostic test; and the third, most important
one——
Mr. RUIZ. Yes. Listen.
Dr. REDFIELD [continue]. Is the workforce.
Mr. RUIZ. Work within a team.
Dr. REDFIELD. We need to build that workforce.
Mr. RUIZ. Be consistent. No discrepancy. Discrepancy breeds anx-
iety. That brings panic. OK?
All right.
Ms. ESHOO. The gentleman’s time has expired.
I wanted to get a commitment so that these agencies don’t lose
the money that they are losing. You are asking them to promise
you even beyond where the cuts are. So I would be happy if that
could happen, but the Congress has a job to do to restore the
money in these agencies.
These cuts are really shameful. They really are. And when we
have such premier agencies, people at the top that know what they
are doing, and they are being cut, and the Secretary is telling us,
‘‘Well, we did $1.5 billion; everything is going to be fine,’’ I don’t
think so.
Dr. Bucshon from Indiana.
Mr. BUCSHON. Yes, thanks for the 5 minutes. I appreciate it. No,
4 minutes. I am just kidding.
Ms. ESHOO. Four minutes.
93
Mr. BUCSHON. I mean, in reference to the funding, I just want
to—I mean, the Congress provides funding for the agencies, and a
the budget proposal is a budget proposal, no matter which Presi-
dent it comes from. So I am not too worried that this Congress
won’t provide the appropriate level of funding.
And I understand also that additional funding—if we could
quickly bring up the supplemental and pass that, that clearly, in
my opinion, it would help if Secretary Azar and all the people at
this table do their job and get money to everybody.
The other thing is I just want to comment briefly on the criticism
of the President and what he has said. If the President of the
United States comes out and incites a panic in the United States;
it incites a worldwide panic. And I see the role of the President as
different than mine or Secretary Azar’s or others. And even though,
you know, the President says what he says, I do think having a
calming effect in a situation like this is appropriate, and allow the
professionals behind the scenes to do their jobs.
I just wanted to say that. And——
Secretary AZAR. And if I could, I agree entirely. I think the Presi-
dent’s role has been actually critical in keeping the country calm
in this situation. He has expressed the levels of doubt and uncer-
tainty with his words that we have but also tried to be reassuring
to the American public as we also try to be transparent about what
the risks are coming forward.
We all have different roles to play here, as you said, and the
President is a very important one, guiding towards balance, matu-
rity, and calm in addressing a public health emergency.
Mr. BUCSHON. I would agree. I mean, if the President came out
and incited a panic; he would be criticized for that.
So I guess, you know, we had this unprecedented containment
strategy when things were in China. Now that we know we have
had problems with person-to-person transmission in Italy and
South Korea and maybe other places, does that change our current
containment strategy?
And, Dr. Redfield, maybe you can address that.
Dr. REDFIELD. Yes. I would say first that we are maintaining ag-
gressive containment. I want to say that, of all the strategies we
have used in this multilayer strategy, the most important one we
have is an astute medical and public health community in the
United States. Of those 14 cases originally that were diagnosed,
only one was picked up by the screening.
So we are now moving, obviously, to educate the American Med-
ical and public health community that it is not just China; we have
to worry about now; we have to worry about certain places of Italy
and Iran and whether it is the Republic of Korea. So we are con-
tinuing with that.
And we are continuing to look at our travel alerts. You know, we
have put the travel alert to Level 3 now for Korea and Level 2 now
for Italy, Iran, and Japan, trying to let the American public know
this may not be the time to go to those areas.
Mr. BUCSHON. OK. Great.
And, again, for you, Secretary Azar, do you have anything to add
to that? OK.
94
Again, Dr. Redfield, as far as the testing goes, the CDC, 12 other
public health laboratories have the testing, but I guess they had
some difficulty with the third reagent in the test. And can you fur-
ther explain the problems with the test? And have those problems
been resolved?
Dr. REDFIELD. So, first, the test really measured three different—
let’s just say, three different nucleic acid pieces. And one of them
had a control; the third one had a control. And, in that control,
there was low-level contamination.
There was never any question about whether the test could tell
positive——
Mr. BUCSHON. OK.
Dr. REDFIELD [continue]. Or negative. It just had a group of indi-
viduals that we had to say we didn’t know.
Mr. BUCSHON. OK.
Dr. REDFIELD. Those samples, again, were at CDC. CDC has con-
tinued, we have doubled—I found out we are at 350 to 500 samples
a day, when the question was asked earlier, that we are running
right now.
Mr. BUCSHON. OK. So the problem has been resolved, basically?
Dr. REDFIELD. The problem is being resolved. We work with——
Mr. BUCSHON. OK.
Dr. REDFIELD [continue]. The FDA. And we have a fix that is
supposed to be operationalized this week.
Mr. BUCSHON. One other quick thing. Have you guys conducted
disease modeling for a potential COVID-19 outbreak in the U.S.?
Dr. REDFIELD. We do have modeling groups. It is a global mod-
eling group that is looking at a variety of different models. And
that is in process. As Tony said earlier, there is still a number of
things we don’t quite know about this virus to make those models
available for prime time, but we are working it.
Mr. BUCSHON. You are working on it. OK. Thank you very much.
I yield back.
Ms. ESHOO. The gentleman yields back.
I think that concludes the questions that we have for you today.
Thank you to each one of you.
Mr. Secretary, you have been here for many hours, and, you
know, throw a punch, take a punch, right? But we are all here for
our fellow Americans—for our fellow Americans.
And I think if there is anything that has come out of this today,
we want facts. We want to bring the temperature down. We want
to bring the fear factor down. And anything and everything that
you can do in order to achieve that, as we move on with Dr. Fauci’s
work, with larger distribution of the diagnostics through the CDC
in partnership with what we have across our country, is going to
go a long way.
So thank you to each one of you.
I am not going to adjourn. You can get up and leave while I read
a very long record of items that need to be placed into——
Secretary AZAR. Thank you, Chairwoman.
Ms. ESHOO [continue]. The record.
Thank you. God bless you and your work on behalf of the Amer-
ican people. Thank you.
95
All right. I am going to request—I have a unanimous consent re-
quest to enter the following documents into the record:a June 28
letter from four House committees to HHS and CMS regarding the
case Texas v. The United States; a December 2018 letter from four
House committees to HHS and CMS regarding the case Texas v.
The United States; an April 2019 letter from five House commit-
tees to HHS and CMS regarding the case Texas v. The United
States; a February 2020 letter from HHS in response to the April
2019 joint letter from five House committees regarding the case
Texas v. The United States.
The committee actually is still in order. I wanted the witnesses
to be able to leave, but if anyone wants to gab, take it into the side
room so that I can read these into the record, please.
A February 2020 letter from HHS in response to the April 2019
joint letter from five House committees regarding the case Texas
v. The United States; an October 2019 Washington Post article en-
titled ‘‘Trump Campaign Urges White House to Soften Proposed
Flavored Vape Ban,’’ unquote; an October 2019 bicameral letter to
HHS from two congressional committees regarding the increased
number of uninsured children in the United States; June 2019 let-
ter from the Energy and Commerce Committee examining HHS’s
administration of the Medicaid program; a statement from Johnson
& Johnson regarding the company’s response to the coronavirus
outbreak; a statement from the American Society for Microbiology
regarding the coronavirus outbreak; a February 2020 article from
BioCentury entitled, quote, ‘‘Biopharma Industry, Academics Push
Back Against Demands for Price Controls on COVID-19 Counter-
measures,’’ unquote; a January 2020 Wall Street Journal opinion
piece entitled, quote, ‘‘Pharma to the Rescue,’’ unquote.
Are there any objections?
Without objection, so ordered.
[The information appears at the conclusion of the hearing.]
Ms. ESHOO. And the subcommittee will now adjourn. Thank you,
everyone.
[Whereupon, at 5:19 p.m., the subcommittee was adjourned.]
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